20060517 (2).pdf0
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DATE RECEIVED
���& PERMIT EXPIRES
CITY OF EDMONDS NUMBER ic� lJ -- 6_
CONSTRUCTION PERMIT APPLICATION JOB SUI E/APT'
ADDRESS
O NER NAME/NAME OF BUSINESS y,. J G'►� �✓�
tit Cj t �i,l (4 r PLAT NAME/SUBDIVISION NO, LOT NO. LID NO.
¢ MAILING ADDRESS ] LID FEE S
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O/ �j I v' �'� PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP Pp
d0oxI 1 l RW Permit l Rego red ❑
Street Use Permit Requued ❑
CITY ZIP TELEPHONE EXISTING PROPOSED ____.._...__..._________ inspection Required ❑
C.SOdendla Required E30.0.AA 6jJ C� J �'
iAG �)`Ld�round E3i, J � REQUIRED DEDICATION FT WinnUnderground
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NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
F- YES [3 NO ❑
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t ADDRESS REMARKS _
U OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE ¢
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CITY ZIP TELEPHONE
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NAME CBL#I • 'T^ ENGINEERING REVIEWED BY DATE
ADDRESS �__ tt r RECYCLE REVIEWED BY DATE
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PUBLICWORKS REVIEWED BY DATE
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STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY FIRE REVIEWED BY DATE ¢
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VARIANCE O7HORELINEORADBI INSPECTION SEPA ee
PROPERTY TAX ACCOUNT PARCEL NO. REO'D COMPLETED I EXEMPT
13 YES i' NO
CA# ZONE SIGN AREA HEIGHT -i
❑ NEW ❑ RESIDENTIAL PLUMBING / MECH ❑ WAIVER ALLOWED PROPOSED ALLOWED PROPOSED v rn
COMMERCIAL COMPLIANCE OR 0 STUDY C v
❑ ADDITION ❑ CHANGE OF USE LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) m
❑ MIXED USE ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR =4 0
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN z 0
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FENCE z _ REPAIR ❑ GRADING CYDS❑rn
( X FT) PARKING LOT AREA PLANNING REVIEWED BY DATE a I jT1 Z
OTHER REO'D I PROVIDED p
❑ DEMOLISH ❑ TANK ❑ ! C z
❑GARAGE RETAINING WALL FIRE SPRINKLER REMARKS r _
CARPORT ❑ ROCKERY ❑ FIREALARM
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'(TYPE OF USE, BUSIN S R ACTIVITY) EXPLAIN: (n
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i NUMBER NUMBER OF
OF DWELLING Tit
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E NSTRU ION C E OCCUPANT
I STORIES UNITS GROUP
DESCRIBE WORK TO BE DONE rn
SPECIAL INSPECTION CONSULTANT OCCUPANT v
LOAD 0 r
REQUIRED YES C rn
REMARKS zM
0 1o�t NSI s I Z n
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GEOTECH REPORT
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V O Vi jm� LA kj& iv I i.(;L n BY
STRUCTURAL DESIGN
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VALUATION D
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Description FEE Description FEE _
IvxA CA
HEAT U CE LOT SLOPE4o VESTED DATE Plan Check State Surcharge Z
Building Permit City Surcharge
PLAN CHECK NO: O_
Plumbing Base Fee M
THIS PERMIT AUTHORIZES ONLY THE WORK NOTE . THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
f DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC,) WILL REQUIRE
J SEPARATE PERMISSION, Grading
f
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5), Engr. Review Recording Fee
L PERMIT LIMIT: SEE ECDC 19,00,006(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection Plan Chk. Deposit
u•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 #
i EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
a ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY Fire Inspection Total Amt: Duo
r FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE p
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 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
1 IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO receipt is acknowledged m space provided
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27. (425) f l( SIG T RE ATE
SIGN TU (OW E AGENT): '1 DATE SIGNED I
7710220 /
G R E D T.
iiiiiii
v EXT. 1333
ATTENTION
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. UBC109 / IBC110 / IRC110, PINK -OWNER GOLD - ASSESSOR
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