20051119.pdfDATE RECEIVED n /,'J
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PIT EXPIRES
P MIT
CITY OF EDMONDS NUMBER&125-6T
CONSTRUCTION PERMIT APPLICATION JOB ! s ITE/APTa
ADDRESS
OWNER NAME/NAME OF BUSINESS
PLAT NAMEISUBDIVISION NO. LOT NO LID NO.
MAILING ADDRESS ( LID FEE $
R PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved O
' r � RW Permit Required O
Street Use Permit Required E3
CITY ZIP TELEPHONE EXISTING PROPOSED inspection Required O
` n ,1_ Sidewalk Required Q
D M of S I Xs 1 o REQUIRED DEDICATION FT Undergrourd 0
l Wmn required O
NAME METER SIZE LINE S1ZE NO, OF FIXTURES PRV REQUIRED
YES 13 NOD z
z
LU
LU
ADDRESS REMARKS w
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE z
E5
z
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CITY ZIP ITELEPHONEG_.r'�rspPxTior�s
IMITI
1411911171
ENGINEERING REVIEWED BY DATE
C ADDRESS II-Zd�
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FIRE REVIEWED BY DATE w
O CITY Z EL P NE tz Z
U 0
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA j
REQ'D COrdPLETED I EXEMPT n
0 YES ONO:M
CA# ZONE SIGN AREA HEIGHT
PRORTY TAX AC NT PARCEL NO. 0
0 � 0 STUDY O
Q(//�rf�(j J�-(f��f� 7 WAIVER O ALLOWED PROPOSED ALLOWED PROPOSED .n
❑ NEW RESIDENTIAL ❑ PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) C M
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
❑ ADDITION ❑ COMMERCIAL ❑ COMPLIANCE OR z IT1 0
❑ MIXED USE CHANGE OF USE z 0
PARKING LOT AREA PLANNING REVIEWED BY DATE g 0 C.
REMODEL ❑ MULTIFAMILY ❑ SIGN REQ'D PROVIDED a • 1
MMS_''❑ FENCE j m REPAIR ❑, GRADING CYDS ❑ m Z
( X FT.) REMARKS �
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❑ DEMOLISH 1:1 TANK El OTHER i D Z
GARAGE RETAINING WALL FIRE SPRINKLER r =
z ❑ CARPORT ❑ ROCKERY ❑ FIREALARM
CA
(TYPE OF USE, BUSINESS OR ACT EXPLAIN: 0 Mn
TYPE OF CsONgTRUCTION GROUP NT R.3OCCUPAU il'/�/Jmn
U) NUMBER NUMBER OF 2
0 OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
LOAD I .• m
p STORIES UNITS rn
REQUIRED � YES Q N
DESCRIBE WORK TO BE DONE rw
t L G REMARKS z 0 M
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iK G •/ ' G K/ GEOTECH REPORT [am 1 Z 0
BY:
STRUCTURAL DESIGN
BY:
VALUATION X
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$ Ztv n.
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Description FEE Description FEE ) 'i
2
C �EXjM Plan Check State Surcharge 50
Z
HEAT SOURCE LOT SLOPE% VESTED. DATE r 0
Building Permit '"' City Surcharge .�
PLAN CHECK NO:� r Plumbing Base Fee �. m
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC Gradin
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g
t SEPARATE PERMISSION,
Engr. Review
w PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
IL PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
•APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk, DepositVA
—'
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND, HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape lnsp. Total Amt. Due
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee 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 This application Is not a permit until signed by the
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• CALL Building Official or his/her Deputy: and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED FOR INSPECTION receipt is acknowledged in space provided.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
VV0 'S N INS NCE AND RCW 18:27, OFFICIALS SIGNATURE DATE
G U N G )' DATE S NED (425) /l i ...
771-0220 ELEASE / (� DATE
ATTNTION EXT. 1333
IT IS NLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTle ORIGINAL -FILE YE LOW - INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC1091 IBC1101 IRC1106 PINK -OWNER GOLD - ASSESSOR
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