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20050104A (2).pdfI CITY DATE RECEIVED PERMIT EXPIRES PERMCITY OF EDMONDS NUMBIER CONSTRUCTION PERMIT APPLICATION ooREss SUITE/AP ER NAMEINAME OF BUSINESS . �0J ^ PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. 2. F -F LID FEE 5 G ADDRESS _ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW pri2L 2mer Approve 0 71 J Street use Ponn,t Required � ZIP TELEPHONE EXISTING PROPOSED _ inspection Require O Sidewalk Require O / Underground N! REQUIRED DEDICATION FT Winn re uved O h S o � .•-� � — - - — -. METER SIZE LINE SIZE NO. FI%TURES PRV REQUIRED J CcbAlob. YES O NO O Z FE W W W REMARKS z L/ �' - OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE J j �7 1 L W TELEPHONE 7 • N)CF Q0n) ENGINEERING REVIEWED BY FIRE REVIEWED BY z CITY —� ZIP TELEPHONE 0 li / STATE LICENSE NUMBER E 1RATION Ke 4 � 7, 62z e PROPERTY TAX ACCOUNT PARCEL NO. ❑ NEW ❑ ADDITION REMODEL ❑ REPAIR ❑ DEMOLISH GARAGE Cl CARPORT (TYPE OF USE, F. NUMBER OF STORIES Z075LO W4643 ❑ RESIDENTIAL APLUMBING / MECH COMMERCIAL COMPLIANCE OR ❑ MIXED USE 1:1CHANGE OF USE ❑ MULTIFAMILY ❑ SIGN ❑GRADING FENCE CYDS ❑ ( X_ Oa R ❑ TANK ' RETAINING WALL FIRE SPRINKLER ❑ ROCKERY ❑ FIRE ALARM NUMBER OF DWELLING / UNITS DATE DATE W S OR CU SHORELINE OR ADB# INSPECTION SEPA n REQ'D COMPLETED EXEMPT CONSULTANT REQUIRED 0 YES O YES ONO GEOTECH REPORT ZONE SIGN AREA. HEIGHT VALUATION ALLOWED PROPOSED ALLOWED PROPOSED EREO'D ERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR G LOTAREA PLANNING REVIEWED BY DATE OVIDED FT.) I REMARKS TYPE OFqPNSTRUCTIONya n v SPECIAL INSPECTION CONSULTANT REQUIRED 0 YES REMARKS GEOTECH REPORT BY: STRUCTURAL DESIGN BY: VALUATION $ //% 177`'' OCCUPANT 1� GROUP OCCUPANT LOAD Description FEE Description FEE Plan Check �� State Surcharge HEAT SO RCE LOT SLOPE% VESTED DATE Building Permit } City Surcharge Affi PLAN CHECK NO: Plumbing Base Fee G egg Mechanical THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC Gradin DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC,) WILL REQUIRE g SEPARATE PERMISSION, Engrg Review PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5) PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection SEE BACK OF PINK PERMIT FOR MORE INFORMATION *APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF Fire Inspection Receipt # EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND p r 517 O;q pie) ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY /�/1 c FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Total Amt. Due �0 v DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. ! _ NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' Receipt # + Recording Fee 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 This application /s not a permit until signed by the THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL 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 receipt is acknowledged in space provided IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S CO ENSATION INSURANCE AND RCW 18:27. FI LS SIGN" f % `TE DATE SIGNED 1425) / �.�`-r`' / e NE "GU R7AG): c NNN ' 1 T 771 -0220 L 'SED BY D E eo t- s EXT. 1333 TE NIv, 44 IT IS UNLA FUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL -FILE YELLOW FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 I IBC110 I IRC110. PINK • OWNER GOLD P 10104 PRESS HARD - YOU ARE MAKING 4 COPIES V O rn cM My �0 C1 17 C �1C =m mZ ID C rX O "11 mm_ 0 N nr M CC4 r Z D Z 2 N O 0 Ir I