20051134.pdfFOATE RECEIVED
f
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ER NAM NAM OF BUSINESS
MAILINGADdRESS
A
CITY TEL PHONE
"P ;e5 -
NAME
W1,11.0c - ,
40DRESS
78t) Z 1 -4 6. 1 -:5
NAAAP CBL#
T:fo
)NDDhE11S
CITY TELIEPHONE
1 7
STAT�E LICENSE NUMBER EXPIR 00ATE
PROPERTY XACCO NTPARCELN
PERMIT EXPIRES
PERMIT
NUMBER
JOB
ADDRESS
PLAT NAME)SUBDIVISION NO.
LOT NO.
I
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
USCIIAPP(oven
Fi%'v PL" 11 Rpqo
13
EXISTING PROPOSED
Silreel Us, P,111�1�1101tjjlfed
Inspeoicin Requirou
C 3
0
Slae�aiit RNU,fod
REQUIRED DEDICA1 ION
FT
Undergloura
1 Wwng fequaea
METER SIZE
L114E SIZE
NO. OF FIXTURES
PRV REQUIRED
I
I
YES [3 NO13
I
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
z
E
W
Lu
z
a
z
Lu
EVIEWED BY `�T f DATE
,,�) P, �,v u ".. , � 1. 3E
;A r pr n n
WFtATE
r ALL HOT
DATE
DATE
VARIANCE OR CU SHORELINE ORADBsf I INS�PEQ�ICN I SEPA
I D COMPLETED EXEMPT
13 YES 0NO I
ui
cc
X
-�7
eg�577
I
CAN
ZONE
SIGN AREA
HEIGHT
NEW
RESIDENTIAL
PLUMBING i MECH
1:1 WAIVER
I
ALLOWED PROPOSED
I
ALLOWED PROPOSED
I
EADDITION
]
COMMERCIAL
COMPLIANCE OR
STUDY
,
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
MIXED USE CHANGE OF USE
REMODEL
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT URSIDE REAR
MULTIFAMILY
SIGN
z
REPAIR
GRADING
FENCE
z
CYDS
x FT.)
PARKING
I
LOTAREA
PLANNING REVIEWED BY DATE
ocnIn PROVIDED
DEMOLISH TANK I I I
GARAGE RETAINING WALL FIRE SPRINKLER REMARKS
z CARPORT ROCKERY FIREALARM
OF USE, BUSINESS OR ACTIVITY) EXP IN:
IL L)
rr "Vec)i ,
U
W NUMBER NUMBER OF
a OF DWELLING
to TYPE OF STRUCTION
0 STORIES UNITS OE
OCCUPANT
GROUP
DESCRIBE WORK TO BE DONE M Z8�
SPECIAL INSPECTION CONSULTANT OCCUPANT
REQUIRED LOAD
REMARKS
7K
GEOTECH REPORT
BY;
STRUCTURAL DESIGN
BY:
VALUATION
$
j40r'::?r/
,,,,o// 5
Description FEE Description FEE
VESTEDDATE
E T URGE L,PE07 Plan Check State Surcharge
&2�
Building Permit City Surcharge
PLAN CHECK NO:
Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Mechanical
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
.j
SEPARATE PERMISSION. Grading
2— .
cc PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
W Engr. Review Recording Fee
916 PERMIT LIMIT., SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr, Inspection Plan Chk. Deposit
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
Lu
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF Fire Review Receipt ft
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Fire Inspection Total Aml, Due
I ? 70
_j DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION., Landscapelnsp. Receipt #
IHE Y CKNOWLED . GETHA I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
G IV R 4 1 CALL This application is not a pLrinit until signed by the
El S QRREC Aq THA AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
T HE I AGI E COM Y WITH CITY AND STATE LAWS REGULATING CONSTRUC- Building ottic(al or his/her Deputy, and Feesare paid, and
I( WOR UTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED FOR INSPECTION receipt is acknowledged in space provided
T , E I -1�
IN 10 SIA B 0 ODE OF THE STATE OF WASHINGTON RELATING TO
W RK IONI RANCE AND RCW 18:27. FIF A SIG AIURE DAT
(425)
GNA DATE SIGNED
771-0220
,e/o� 15� RELgiSiEn Illy f)AT/E
z EXT. 1333 ------------------- L_�
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL - FILE YELLOW - INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1 09 / IBC1 10 / IRC11 10. PINK -OWNER GOLD - ASSESSOR
6/05 PRESS HARD - YOU ARE MAKING 4 COPIES
0
z
M
z
0
i
0
M
-A -n
M
C
M
0
-40
0 C7_
q M
X M
M z
IC) —1
C _z
0)
0 71
ri
M M
0
0
0 M
C cl)
Q 0
Z
;U
__4
z
z
'0
I
0
M