20050193.pdfDATE RECEIVED
PERMIT EXPIRES
se
CITY OF EDMONDS ZONE ) `.� PERMIT 5'
CONSTRUCTION PERMIT APPLICATION JOB NUMBER r✓� _ �, c:
ADDRESS SUITE/APT#
�j n� lj/b
OWNER NAME/NAME OF BUSINESS �'G(J
PIAT NAME/SUBDIVISION NO. LOT NO. LID NO.
CIA Is MA LING ADDRESS
z
I LID FEE f
O- ❑
�j PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved
Permit Required ❑
CITYStreet Use Permit Roq'd L3ZIP. TELEPHONE EXISTING
PROPOSED Inspection Required ❑
Sidewalk Required 13
REQUIRED DEDICATION FT Underground
NAME Wiring required ❑
n METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
GYO
R E S YES ❑ NO ❑
REMARKS Z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
z
ZIP
CITY TELEPHONE w
7 7'-f -aa1
NAME CBL q
�s�crr�r-itow 4 '�
ENGINEERING REVIEWED BY DATE
CC ADDRESS
.p.
C TYZIP FIRE REVIEWED BY DATE w
O TELEPHONE
trx/ 9$�I 7ae 844
STATE LICENSE N MBER EXPIRATION DATE CHECKEP BY VARIANCE OR CU SHORELINE OFQDEINSPECTION BOND
-� \RE 'D POSTED
GDk co3 t o µi of l0 D8 c� (/ ! C2vrt I S NO it
Q PROPERTY OUNT PARC L NO. SEPA REVIEW SI N AREA HEIGHT
^� COMPLETE EXEMPT ALLOWED PROPOSED /ALLOWED PROPOSED
EXP NU C a {
❑ NEW ❑ RESIDENTIAL ❑ PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBA S (FT.)
❑ CHANGE OF USE ALLOWED p OPOSED FRONT SIDQ REAR
FRONTO L/� Ip REAR
❑ ADDITION ❑ COh1MERCIAL COMPLIANCE OR /•V //iVp G yl �dV� �Jj�JI !l'_ Z
z
z
❑ REMODEL MULTIFAMILY PARKING LOT AREA P NING IEW BY DATE, g
❑ SIGN REO'D PROVIDED ,J a
REPAIR ❑ GRADING CYDS ❑ FENCE �� Q7
(. X FT) REMARKS
❑ DEMOLISH ❑ TANK ❑ OTHER
Z
❑ CARPORT ❑ GARAGE RETAINING WALL ❑ FIRE SPRINKLER 1'lf I q T e �d G� 6L f /L 1 TO
0 ROCKERY FIRE ALARM
(TYPE OF USE, BUSINES OR ACTITY) EXPLAIN:rc AA 57-1ok
" CHECKED BY TYPE 0 NST CTION O E OCCUPANT
NUMBER NUMBER OF CRITICAL GROUP
p h I'
m OF DWELLING AREAS SPECIAL INSPECTION AREA OCCUPANT
A STORIES UNITS � � NUMBER REQUIRED
DESCRI WORK TO BE NE [:1 YES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/I8C109/IRC109 FINAL INSPECTION REO'D z
VALUATION
Description FEE Description FEE
k State Surcharge
HEAT SOURCE GLAZING % LUT SLOPE%
Building Permit % M City Surcharge l^
PLAN
CK7; ; ` VESTED DATE 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
7 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
t SEPARATE PERMISSION.
i Engr. Review
PERMIT APPLICATION: ISO DAYS
PERMIT LIMIT. 1 YEAR -PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION g • p tion
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGF.N TS FROM ANY AND Fire Inspection
` ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY Receipt N
T FROM THE ISSUANCE. OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OH REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt, Due
Y NOR LIMIT IN ANY WAY THE CITY'S ABILITY 10 ENFORCE ANY ORDINANCE PROVISION'
Recording Fee Receipt N 2C�
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION; THAT THE INFORMATION
11
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
'THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC•(,•ALL This application is not a permit until signed by life
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/hor Deputy. and Foos are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided
WORKMEN'G COMPENSATION MANCE AND RCW 10.27.
NA R DAT F:
IG
SIGNATURE (OWNER OfiGENT) ^ DATE SIGNED (425) OFF Cl l"
771-0220<
ELEASEO BY DATE
A NTION �-t-�.-y�-z(:>���' EXT 1333 . -- T -
IT IS UNLAWFULTO USE OR OCCUPY BUILDING OR S R TORE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OFOCCU-
PANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110. ORIGINAL - FILE ELLOW • INSPEC ron
PINK •OWNER GOLD•ASS[SSOH
os/o3 PRESS HARD -YOU ARE MAKING 4 COPIES