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20051112 (2).pdfDATE RECEIVED� ,. �(�,�,,� I G� C� ✓ PERMIT EXPIRES CITY OF EDMONDS NIT CONSTRUCTION PERMIT APPLICATION JOB SUITE/APTe ADDRESS .z 3 30�' OWNER NAMFJNA OF BUSINESS PLAT NAMEiSUBDIVISION NO. LOT NO. LID NO. ¢ MAILING ADDRESS 6 LID FEE S w 3 �D 1 1^ I7 T[SCR noorovca ❑ "' PUBLIC RIGHT OF WRY PER OFFICIAL STREET MAP T r andifoved W ❑ S Cse Permit Regdueo ❑ CITY ZIP TELEPHONE EXISTING _ __.:. .._ ___ jPROPO$Eb k %,"f`- j•_f __musil m�finFou�mtl ❑ ��f J i _ is �-(,( 4'h0 k N cI D2 REQUIRED DEDICljT10N..� / .Ff {�: .} ii M e U'Rfea a NAME METER SIZE t t' L.H - 5I + 14O.0f it F S PRV REQUIRED F T��EJ1 ! rSS f YES CI NO E3 i ADDRESS REMARKS ' z OR U OWNER/CONTRACIRESPONSIBLE FOR EROSION CONTROUDRAINAGE ¢ ¢ tu a w z CITY ZIP TELEPHONE r, z w dg= NAME CBLa //,C� 0 ENGINEERING REVIEWED BY _ DATE Gh,Ggt� SUmZ 001 teal Pe rmit frim cc ADDRESS RECYCLE REVI Q n { stg rje DATE leee rdc wo� 5 S • L a ��e o' Stt�te L"b'r Il 11 ¢ PUBLIC WORKS EVIE DATE i CITY, ZIP TELEPHONE Seq}f-le 67 lyZoo .3zq• got Z STATE LICENSE NUMBER IEXPIRATION DATE Y FIRE REVIEWED BY DATE Let RELINE SEPA cc OmVARIANCE OR CU R REQ'D CDrvi PROPERTYTAAX ACCOUNT PARCEL NOPLETED EXEMPT 0 YES NOO© O DI!47© CAN ZONE SIGN AREA HEIGHT E5 'SEW ❑ RESIDENTIAL LUMBING MECH E3WAIVER AuowcD PROPOSED ALLOWED PROPOSED Z Q COMMERCIAL CO!dPLIANCE OR ❑STUDY 0 M �DITION ❑ CHANGE OF USE. LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) C ❑ MIXED USE ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR m FeelREMODEL❑ MULTIFAMILY ❑ SIGN z Q C GRADING FENCE ❑ REPAIR ❑ CYDS ❑ ( X FT.) PARKING LOTAREA PLANNING REVIEWED BY DATE j = m , REO'D PROVIDED a I (71 Z ❑ DEMOLISH ❑ TANK ElOTHER I I Jfl GARAGE RETAINING WALL FIRE SPRINKLER REMARKS II D'Z z ❑ CARPORT ❑ ROCKERY ❑ FIREALARM f r = n(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: I O .tet w NUMBER NUMBER OF I m OF DWELLING % 1 TYPE OF CONSTRUCTION CODE OCCUPANT D p STORIES. UNITS �,j A GROUP 16 _ DESCRIBE WORK TO BE DONE /�� I m m SPECIAL INSPECTION CONSULTANT OCCUPANT ! 0 N TL LOAD ,/• h S �1 . REQUIRED 0 YES m T 1 I REMARKS z 1 C N eb C ea o r Q n I GEOTECH REPORT I Z r /OlU 0 1; BY �n STRUCTURAL DESIGN Bye $VALUATION i Lire, CQIC� ` Ara00� � Z Description FEE Description FEE qQ 4o _ HEAT SOURCE LOTIELOTE96 VESTED DATE Plan Check State Surcharge rA Z PLAN CHECK NO: Building Permit City Surcharge O Plumbing Base Fee I M THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO Mechanical t BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE I= SEPARATE PERMISSION, Grading I LU PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5) Engle, Review Recording Fee CIL PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engle. Inspection Plan Chk. Deposit I W *APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS , IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF Fire Review Receipt # 2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY Fire Ir1SpeC110n Total Amt. Due FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE u� DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.• Landscape Insp. Receipt # I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF CALL This application is not a permit until signed by the THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• FOR INSPECTION Building Otficial or his/her Deputy: and Fees are pard, and TION; AND IN DOING THEW AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED receipt is acknowledged in space provided IN VIOLATION OF THE LABOR DE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'SCOMPENS SU NCE ANDRCW18:27, �AnC� OFFI LS ATURE DATE SIG U E (OWNER ENT); r GATE SIGNED j 425 �h1ey �'� P1� 771 -OZ2O RELE D J A E V C/ EXT. 1333 �, Z AT ENTION IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI ORI GI L • FILE • YELLOW • INSPECTOR FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109 / IBC110 / IRC1109 PI K - OWNER • GOLD. - ASSESSOR 6105 PRESS HARD - YOU ARE MAKING 4 COPIES