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20051149.pdf'00 �,1 j / DATE RECEIVED .�� �i PERMIT EXPIRES _ � r CITY OF EDMONDS NUMBERO2(1Z� - CONSTRUCTION PERMIT APPLICATION JOB SUITE/APTn ADDRESS / OWNER NAMEINAME OF BUSINESS q V% L f�l- 99 �Kv• /h /i PLAT NAMEJSUBDIVISION NO LOT NO. LID NO. Lu MAILING D RESS LID FEE S � j L�/ !p ��! l PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TLSCP Approvon OOOM, ❑ ✓ 111 l K I N • RW Point Regwrect ❑ CITY ZIP TELEPHONE EXISTING Sheet use Perrot Required ❑ .__._...__-..__ PROPOSED.-'----_---...—'—`---.—_-- InspecfonRequ,reo ❑ SdeWaIK Regwreo ❑ REQUIRED DEDICATION _,____ FT _ underground ❑ -- Wmn fecivaeo ❑ NAME h METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED U � " ��' "'rrr���aaa ,q 6 YES la NO I7 Lu t ADDRESS REMARKS z U �� OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE 0Lu QM m!2 w CITY - z "LIP TELEPHONE 0 .•• _ /] ' w f Y NAME CBL# ENGINEERING REVIEWED BY DATE ¢M ADDRESS RECYCLE REVIEWED BY DATE L) 32,36L/ L/• CITY ZIP TELEPHONE PUBLIC WORKS REVIEWED BY DATE 98(103 1.2S� X9,7 7cZ9 STATE LICENSE NUMBER EXPIRATION DATEC BY FIRE REVIEWED BY DATE W SC h p o 0 / 2— LL PROPERTY TAX ACCOUNT PARCEL NO. VARIANCE OR CU SHORELINE OR ADB4 INSPECTION SEPA Q REQ'D COMPETED EX.ENPT W jDYES D NO fff---111 CA# ZONE SIGN AREA HEIGHT ❑ NEW❑zC ESIDENTIAL 1:1PLUMBING / MECH 13WAIVER ALLOWED PROPOSED ALLOWED PROPOSED wOMMERCIAL COMPLIANCE OR I3 STUDY ❑ ADDITION ❑ CHANGE OF USE LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) MIXED USE ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR �EMODEL ❑ MULTIFAMILY ❑ SIGN z ❑ REPAIR ❑ GRADING CYDS FENCE a ❑ ( X FT.) PARKING LOT AREA PLANNING REVIEWED BY DATE a ❑ DEMOLISH ❑ TANK ❑ OTHER REO'D I PROVIDED z ❑GARAGE RETAINING WALL FIRE SPRINKLER REMARKS _ CARPORT ❑ ROCKERY ❑ FIREALARM IPI (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: /1� E c NUMBER NUMBER OF m OF DWELLING . UREQUIRED RUCTION CODE o STORIES UNITS Z DEESCRIB'E}"��O,RK TOOJ BE DONE - . co I C�C'JV`jT7�—LJC�/V TION CONSULTANT 12 YES `-�► GEOTECHREPORT�/� STRUCTURAL DESIGN BY: VAI I IATI(114 OCCUPANT GROUP # : ' M 0 Description FEE Description FEE HEAT SOURCE LOT SLOPE% VESTED DATE Plan Check �^ State Surcharge 5V PLAN CHECK NO: L-- Building Permit q City Surcharge ©l �/ J Plumbing 7 Base Fee11111 1 .�. THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO Mechanical BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC S DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC,) WILL REQUIRE SEPARATE PERMISSION, Grading PERMIT APPLICATION: SEE ECDC 10.00.005(A)(5) Engr. Review Recording Fee CL PERMIT LIMIT: SEE ECDC 19,00.005(A)(6) SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Ir1SpeC110n Plan Chk. Deposit V)) *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 # M EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY Fire Inspection Total Amt. Due U� C FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE D 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.* Landscape Insp. Receipt # tC7J— 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL GIVEN IS CORRECT; AND THAT 1 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- 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 IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO receipt is acknowledged in spat© provided WORKMEN'S COMPENSATI URANCE AND RCW 16;27. A n C) O LS S ' TURE 0 TE 1 01111111 SIGNATURE (OWNER 0 GENT): DATE SIGNED �/771 �U2 alf 20 R LE ED BY ATE ATTENTION EXT. 1333 IT UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110. ORIGINAL FILE YELLOW INSPECTOR PINK -OWNER •GOLD •ASSESSOR 6/05 PRESS HARD On YOU ARE MAKING 4 COPIES FINAL PROJECT APPROVAL FORM