20060403.pdfDATE RECEIVED t ,
PERMIT EXPIRES
CITY OF EDMONDS
PERMIT
CONSTRUCTION PERMIT. APPLICATION_o
IOB qq
SUITEIAPTn
ADDRESS !�
OWNER NAME/NAME OF BUSINESS f`V� How
PLAT NA ML,SUBDIVISION NO LOT NO, LID NO.
W
MAILING ADDRESS
z / LID FEE S
0 eg/ % PUBLIC.RIGfIT OF WAY PER OFFICIAL STREET MAP TESCP Anprovno ❑
RW Perms Regwrea [3CITY ZIP TELEPHONEEXISTING ffi0POSED Street Use Permit Requued 13 .. __. . Inspection peUwretl ❑
. Siaehalh Required ❑.
fILOUIRLO DLDICAIION FT Underground ❑
NAME - -..._— ––`-----•— Wirino re idea ❑
ME I LN t IZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
U
t Lu ADDRESS YES E3 NO ❑
x REMARKS m
QOYVtJFN'CONTRACTOR HESPONSIBLE FOR EROSION CONTROUDRAINAGE z
CITY Lu
ZIP TELEPHONE z
C7
z
w
NAME CBLp
ENGINF.FRING REVIEWED BY DATE
ADDRESS
RECYCLE REVIEWED BY DATE
bq
G CITY ZIP TELEPHONE PUBLIC WORKS REVIEWED BY
DATE
L) 7�
L+�� o6)S094!5 3 8 63
CTAT,
1 IC CAIc r_ r.0 umrn
-1 PROPERTY TAX ACCOU
y)
W 1 I
J
❑ NEW
❑ ADDITION
❑ REMODEL
❑ REPAIR
❑ DEMOLISH
z ❑GARAGE
CARPORT
O
(TYPE OF USE, BUSINE!
c NUMBER
OF /o STORIES
DESCRIBE WORK TO BE
EXPIRATION DATE QkeeKED BY FIRE REVIEWED BY DATE W
LL
(PARCEL NO. VARIANCE OR CU SHORELINE OR
ADHINSPECTION SEPA
000
A EO'D COMPLETED E
XEfGPTo0 L"YES ❑NO&J04_
RESIDENTIAL CAN ZONE SIGN AREA HEIGHT
PLUMBING i MECH WAIVER - ALLOWED PROPOSED ALLOWED PROPOSED
COMMERCIAL COMPLIANCE OR ❑ STUDY Z 448
alp
IXED USE E3CHANGE OF USE LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
MULTIFAMILY IV SIGN ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
❑
❑ GRADING CYDS ❑ FENCE z
doo
l X FT.) PARKING LOT AREAPLANNING REVIEWED BY DATE 4
a OTHER REO'D I PROVIDED p a
❑ TANK JI/ ��U ✓ L
❑ ROCKERY RETAINING WALL FIRE 1:1 FIRE ALARM LER REMARKS I
NUMBER OF
DWELLING
UNITS
h OCCUPANT
GROUP
CONSULTANT OCCUPANT
/ 0 REQUIRED YES I LOAD
REMARKS
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY*
$VALUATION
Description FEE Description. FEE
HEAT SOURCE LOT SLOPE% VESTED DATE Plan Check State Surcharge
PLAN CHECK NO: ,� / Building Permit o City Surcharge
Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Mechanical
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC,) WILL REQUIRE
t SEPARATE PERMISSION. Grading
w PERMIT APPLICATION: SEE ECDC 19,00,005(A)(5)
Vr. , a En Review PERMIT LIMIT: SEE ECDC 19,00,005(A)(6) g Recording Fee
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr, Inspection Plan Chk. Deposit
(A 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF Fire Review Receipt N
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 Amt. Duo -'
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.' Landscape Insp, Receipt a
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
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application Is not it permit until signed ny the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED FOR INSPECTION Building Ohlclal or his/her Deputy grid Fees am p,ed and
IN VIOLATION OF THE LABOR.Pei THE STATE OF WASHINGTON RELATING TO receipt Is acknowledged In spaco provultio
WORKMEN'S COMP T SURANC AND RCW 18:27, �A n ALS5IGNA iE DArL
SIGNATURE GENT) DATE SIGNED 42
771 WO sk
R \SE7YIJA 4111 f
AT T EXT. 1333
IT IS 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 / IRC1101 ORIGINAL - FILE • YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
6iI PRESS HARD - YOU ARE MAKING 4 COPIES.
O
0
M
cM
m0
-� 0
OC
IT1 Z
Q
C Z
r _
0)
0 mn
I
MM
(7 N
nM
r Z r
�Tl
DX
I
Z
Z
O
n .
M