20051151.pdfDATE RECEIVED
il o C) [PERMIT EXPIRES
PlftRMIT
CITY OF EDMONDS NUMBER
.CONSTRUCTION PERMIT APPLICATION JOB ,,SUIVAPT;r
ADDRESS
OWNER NAME/NAME OF BUSINESS I �
54 PLAT NAMEj SUBDIVISION NO LOT NO. LID NO.
I
LM MAILING ADDRESS
u LID FEE S
z TESCPAPP(Ovecl E3
2' �0 23 0� 5 r PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP AW Point Requaed
0 [3
Sireet Use Perml Requ,ted 13
CITY ZIP TELEPHONE EXISTING PROPOSED___ inspeci,on Retrwred 13
Siae�alK ROqU,10d C3
REQUIRED DEDICATION ___ FT. n ergro . und C3
V2 1-14 Moncl too
7 2'. uaerr C3
NAME MEIER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YESM NO13
U
Lu
t ADDRESS REMARKS
OWNERtCONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE z
U
cc
U)
CITY ZIP TELEPHONE
0
4yp e 02' t ViEllitit ILV)AAAIC z
LU
fiLaLh, Aug 4)pplinncps jasculic"
NAME BLO ENGINEERING AEVlEWEETTSNIU
J,through unbeated spaces.
I
ALV�r'6_ 7A Dit? 11-1
M AbDRESS RECYCLE REVIEWED BY DATE
tIY6 14 .,U)ik
cc PUBLIC WORKS REVIEWED BY DATE
ZIP TEL&AONE
64&� 2F3 Yo 1 3 60 i6f
STATE LICENSE NUMBER EXPIRATIO DATE CHECKED BY FIRE REVIEWEDrY DATE W
n
Ob
-71 r-) S.� OR&INE OR AW#8
Affig_6,!�v � %A btatp t ktX Irtrtm EPA
PROPERTY TAX ACCOUNT PARCEL NU. ! NO ETID , EXENIPT
91 _ _e- or&
NEW
�3rRESIDENTIAL
_[R005`LUMBING0
CA#
13 ZIVER
I
4UNt
ALLOWED PROPOSED
SIUN j:
I
LIUM I
AL PROPOSED
ADDITION
COMMERCIAL
COMPLIANCE OR
1:1
[3 STUDY
I
-
MIXED USE
CHANGE OF USE
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SET13ACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT URSIDE REAR
REMODEL
MULTIFAMILY
SIGN
z
REPAIR
FI
GRADING
CYDS
FENCE
x FT.)
z
PARKING
LOTAREA
PLANNING REVIEWED BY DATE
REO'D PROVIDED
DEMOLISH
13
TANK
Ei OTHER
i
GARAGE
i
RETAINING WALL
FIRE SPRINKLER
REMARKS
z
CARPORT
ROCKERY
FIREALARM
(TYPE OF I IQF: pi ICIN11=0C nO AOTWITY) EXPLAIN:
NUMBEA
OF
NUMBER 0
DWELLING
in
ui
OCC "'A
TYPE
0
STORIES
NITS
_nSTfl�CTION
I M
GROUV9
I
Xl-\ I
DESCRIBE WORK TO BE DONE
SPECIAL INSPECTION
CONSULTAf4T
6CCUPANT
LOAD
REQUIRED
-cl,
L-0-
REMARKS
z
I
g6�
GEOTECH REPORI
BY!
M
STRUCTURAL DESIGN
BY:
Description
FEE Description FEE
HEAT SOURCE LOT SLOPE% VESTED DATE
Plan Check
State Surcharge
Building Permit
City Surcharge
PLAN CHECK NO:
Plumbing
Base Fee
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
9 DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
Grading
t: SEPARATE PERMISSION.
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
Engr. Review
Recording Fee
IL PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
Plan Chk. Deposit
in 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
0
uj IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
Fire Review
Receipt #
_j
2 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
* FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
0 DEEMED TO MODIFY, WAIVE Oil REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
LandscapeInsp.
Receipt # j
1 (4-
X1
1 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 perinit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
Building 011icial or hisiher Deputy, and Fees are paid, and
FOR INSPECTION
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
receipt is acknowledged in space provided
IN VIOLATION OF THE LAaOU-rODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENS 2== AND RCW 18:27.
(425)
OFFiCiA TE
NT)/ DATE SIGNED
SIGN=
771-0220
[did
RELEASErl- DkE I
—IS
EXT. 1333
ATT
rLAWFT
IT U 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. UBC109 / IBC110 / IRC110.
PINK - OWNER GOL D -ASSESSOR
W05 PRESS HARD - YOU ARE MAKING 4
I
COPIES
z
0
11
0
M
--I T1
ITI
C
MO
0
0
0 C::
M
M Z
0 -n
A
M M
0
0
0 M
C cl)
r, C0
M 0
Z
701
X
z
z
0
i
0
M