20050227.pdfDATE RECEIVED
[PERMIT*EXPIRES L ,�
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITEIAPT#
OWNER NAMEINAMTE OF BUSINES{Sy/� / J► ADDRESS I - 1 U - I7U N C; L T A V F ��✓
E LJ ;O N f s S S VPP I I\I V M A L L PLAT NAMEISUBDIVISION NO. LOT NO, LID N0.
w MAILING ADDRESS ! LID FEE S
�� e s Yh wC_Y ssTT` 7,CT� AALz_ I PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP 1 ESCP Approved ❑
0 - RW Permit Remared ❑
Stmet Use Permit Requited E3CITY
C?
7 ZIP TELEPHONE EXISTING PROPOSED _ ._ inspection Requited ❑
�,Ff�i'tLF_ 91Z.. I z� $WeWdlk Required 11REQUIRED DEDICATION FT Underground ❑
—
Winne required ❑
NAME Ilnn METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
F
VVI" C Q N SU L �I Nle tV1 lY /t1� �Ni [=•(V I YES 0 NO O
W rz
L" ADDRESS REMARKS W
C) �) I` L= OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE w
I` z
CITY ZIP TELEPHONE
K I�KU�ND °l�Gs�� %IL7� — 9Z7 Ll7 E3 .
NAME i CBL#
� SPFFT�t4 L-TAL
N . ENGINEERING REVIEWED BY DATE
ADDRESS
La 7S 32 - Z 1 Z_'n4
FIRE REVIEWED BY DATE W
z CITY ZIP TELEPHONE
u LYA N UJD11rM G190MLO "zr� LD7 L 1 -if 30 LL
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY VARIANCE OR CU PHORELINEORADB# INSPECTION I SERA
REQ'D 4 COMPLETED EXEAIP
C/A.S CAK S 1 514 L 1 05 U 1 O .- O YES gNO 1111111,
CA# ZONE SIGN AREA HEIGHT
a PROP TY TAX ACCOUNT PARC NO.
WAIVER ALLOWED PROPOSED ALLOWED PROPOSED
00
W.t L STUDY
NEW ❑ RESIDENTIAL ❑ PLUMBING ! MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR t,
COMMERCIAL COMPLIANCE OR —� z
❑ ADDITION ❑ CHANGE OF USE i
❑ MIXED USE PARKING LOT AREA PLANNING REVIEWED BY DATEg
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REQ'D PROVIDED
FENCE
GRADING
❑ REPAIR ❑ CYDS ❑ ( X FT.) REMARKS
❑ DEMOLISH ❑ TANK Q 010t CVT
GARAGE z ❑ CARPORT ❑ ROCKERY NING WALL ❑ FIREA ARM FIRE LER
a(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
z /, OF CO TRUCTION CODE OCCUPANT
GROUP
w NUMBER NUMBER OF
c OF I DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
0 STORIES UNITS LOAD
REQUIRED 13 YES
DESCRIBE WORK TO BE DONE
= N S-iA LL ZS 1-*Cla r 77R A L M t� l KITE ANCC REMARKS z
0
Y CjDr` L) UJ=z R -. 7=:\4k\ <Tl N CD GEOTECH REPORT
BY: m
STRUCTURAL DESIGN
BY:
VALUATION
%I% � mss, �•
Description FEE Description FEE
I
Plan Check State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE
Building Permit 1 City Surcharrge
PLAN CHECK NO: Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO MBChanIC81
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC Gradin
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC,) WILL REQUIRE g
SEPARATE PERMISSION. Engr. RCVIBW
m PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
a PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection
W•APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk..Deposit
W IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
i EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
= FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE _..
OLandscape Insp: 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.'
Recording Fee Receipt # rG
I HEREBY ACKNOWLEDGE THAT 1 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 is not a ponnn until signed by the
THE OWNER. 1 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 receipt is acknowledged in space provided.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S COMPENSATION INSURANCE AND RCW 48:27. 0 1 ALS S GN TURE DATE
DAT SIGN D
SIGN RE (OWNER O G NT)� I (� (425)
! V V 771=0220 R LEASED BY DATE
ATTENTION I 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- ORIGINAL •FILE YELLOW -INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109 1 IBC1101 IRC110, PINK -OWNER • GOLD ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
Z
Q
0
M
C
M
�O
On
mZ
g)
C