20051165.pdfe �
DATE RECEIV D � G
G' �6 PERMIT EXPIRESPERMIT
_
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB J / QUITE APT#
ADDRESS / '�O %� % / `'7a1 /l
OW ER NAME/NAME OF BUSINESS
r �� �"
PLAT NAMFISUBDIVISION NO, LOT NO. LID NO.
M MAILING ADDR S ,! // LID FEES
17615i /,Q� PUBLIC RIGHT OF WAY PER OFFICIAL. STREET MAP TEfjormA rowed
O
RL SCP
PAP fovea tl
Sveet Use Peml Required
CITY
� ZIP TELE/PHONEr// EXISTING --PROPOSED _.._ InspeclK RRequiroU
eau -red
L(�/,�Tv) (�. • /...%FT __. underground
REQUIRED DEDICATION w,ncr r,• ,..ren
NAME
ADDRESS
NAME
�/
Lil,/ i N
ADDRESS
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES ❑ NO ❑
REMARKS
O .f�yQGi��af SCA .:ACL sG�
e
Type l B or L vent connectors/
' . •
• '
.
KC,�•t.��,ritZ'�4�ii��lLr�t1.j,� '-
a
z
W
w
z
zz
W
C^ ZIP TELEPHONE �, PUB4c WPIKS EVIEWEP BY � DATE.
/7D Z r/17
STATE LICENSE NUMBER EXPIRATION DATE C BY FIRE REVIEWED BY ATE W
OEM 7 l�
PROPERTY TAX AC OUNT PARCEL NO. VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
Q ('' %f' �y-'� REQ'D COMPLETED EXEMPT
J G/ C 011+-/ ( v Yo V t J I� YES 0 NO
CAIt GHT
❑ NEW RESIDENTIAL PLUMBING / MECH ❑ WAIVER t A41.0 PROPOSED ALLOWED PROPOSED
❑ COMMERCIAL [3 STUDY
bt81n'EIee nein ermi from
❑ADDITION COMPLIANCE OR
❑ MIXED USE ❑ CHANGE OF USE LOT ALLOWED CO
P OPOSED FRONS ND SIDE REARM I WPOSEDONT S I BACKS
(FT)
❑ AR
REMODEL❑ MULTIFAMILY ❑ SIGN
z
El REPAIR CYDS ❑ GRADING ❑ FENCE a
( X FT.) PARKING LOTAREA PLANNING REVIEWED BY DATE a
❑
OTHER REQ'D I PROVIDED DEMOLISH ❑ TANK E]
z ❑GARAGE RETAINING FIRE SPRI
CARPORT ❑ ROCKERY WALL 13FIREALARM LER REMARKS
a (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN
U
FE
U) NUMBER -'7NUMBER OF
m OF �/� WELLING
o STORIES NITS TYPEMNSTRU N CO 2.1 GRR PAN
DESCRIBE WORK TO BE DONE
SPECAL IN9PECTION CONSULTANT OCCUPANT
LOAD
vIa! REQUIRED 13YES
REMARKS
GEOTF.CH REPORT m
BY.
STRUCTURAL DESIGN
c�J ls BY
$VALUATION
Description FEE Description FEE
HEAT SOURCE LOT SLOPE96 ` VESTED DATE Plan Check State Surcharge
PLAfN CHECK NO: Building Permit City Surcharge
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
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
t SEPARATE PERMISSION, Grading
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
a PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Review Recording Fee
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr, Inspection Plan Chk. Deposit
N •APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
ul 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
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Fite Inspection Total Amt. Due
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
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- Budding Olhcml or sther Deput and Foos 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 roceipt is ck owledged spare provided
WORKMEN'S COMPS T ANCE AND RCW 18:27. (425) OFFI IA At R' TE If
SIG URE (OW R G T): DATE SI NED 022 771-0 C
l/ L G
O RELEA'E BY ATE
EXT. 1333
TTENTION
IT IS UNLAWFUL TO US 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 = YOU ARE MAKING 4 COPIES
CA
on Mn
i
MM
ON
0 m
C W i
r Z0
NMI
� 1
D i
Z
X
Z
O
n
M
Z
0
n
M
—1
'TI
C
M
�O
OC
mz
fJ
'�
D
Z
rMr
CA
on Mn
i
MM
ON
0 m
C W i
r Z0
NMI
� 1
D i
Z
X
Z
O
n
M