20050460.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS �L r
MAILING ADDRESS
Pi U r wRC2x /6201
CITY ZIP TELEPHONE
TELEPHONE
7 I �_-
PERMIT EXPIRES
PERMIT
NUMBER
JOB ATFf! A t#
ADDRESS (� /
PLAT NjMEISUBDIVISION NO. LOT NO LID NO
6r*) 5 - ^ A LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApproved O
RW Permit Requited 0
Street Use Permit Requited 0
EXISTING ~� PROPOSED Inspection Required O
Sidewalk Requited 1E3
REQUIRED DEDICATION FT Underground O
Wiring required 0
E ER SIZE LINE SIZE NO. OF FI TURES PRV REQUIRED
%F 1.1( YES D NOD Z
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REMARKSW
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE �� 3
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NAME CBL# l�
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GINEERING REVIE'tNED BY DATE
ADDRESS
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CITY 4fy ZIP TELEPHONE FIRE REVIEWED BY DATE w
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STAT LICE SE NUMBER EXPIRATION DATE CIIIIIIIII
D/BY' VARIANCE OFt CU SHORELINE OR ADB# INSREO'D N SEPA
'D COMPLETED EXEMPT m
0 YES L+sNO
CA# ZONE SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. . _
�-y� �y WAIVER 77� ALLOWED PROPOSED ALLOWED/ PROPOSED
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NEW RESIDENTIAL PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) .0 M
ALLOWED PROPOSED O C o
❑ COMMERCIAL N A Z m
COMPLIANCE OR CS C7 t I O
❑ ADDITION ❑ CHANGE OF USE j �G 3 / �' C� �� �' i!' z 0 C
❑ MIXED USE PARKING LOTAREA PLANNING REVIEWED BY DAT 5 O C
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REQ'D PROVIDED ��al IL
2 2 �Qqt� = m
G FENCE ' m Z
❑ REPAIR -� CYDS . ❑ ( X FT.) REMARKS 10 �
❑ DEMOLISH 1:1 TANK ❑ OTHER D Z
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GARAGE RETAINING WALL
CARPORT ❑ ROCKERY ❑ FIRE SPRINKLER =
FIREALARM .�
XTYRE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: 0
TYPE OF Ot�S CTION CS%Q OCCUPANJ b
GROUP
NUMBER NUMBER OF =
OF DWELLING SPECIAL INSPECTION CONSUL T OCCUPANT m M
STORIES UNITS a LOAD
REQUIRED 13 YES 0 rn
DESCRIBE WORK TO BE DONE �. r
REMARKS i C N
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L L & GEOTECH REPORT
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BY:
` , VALUATION
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Description FEE Description FEE _
Plan Check / `� State Surcharge J N
HEAT URCE Z
LOT SLOPE% VESTED DATE •� I
Z Building Permit ' City Surcharge } =4
PLAN CHECK NO:
Plumbing ` Base Fee �j I M
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical /
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC �.
E DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC:) WILL REQUIRE Grading
5
SEPARATE PERMISSION,
rEngr. Review,
j
u PERMIT APPLICATION: SEE ECDC 19.G0.005(A)(5) I
L PERMIT LIMIT: SEE ECDC 19.00,005(A)(6)
Engr, Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
i
`APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk, Deposit 1 �'
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
X EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt # r C
a ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE i 1
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due
= NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee Receipt # %
1 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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• This application sl not a permit until oesa r by id,
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Oficial or hislhar Deputy: and Foes aro paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TOFOR INSPECTION receipt is acknowledged in space provided
WORKMEN'SC SATION IN NCE AND RCW 18:27.
C• DAT
SIGN (OW h ER)D R AG DATE SIGNED 425 /
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7ATNTION EXT. 1333vAWFUL TIYUSE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL -FILE • YELLOW • IN PE OR
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109 I IBC110 I IRC110. PINK • OWNER • GOLD • ASSESSOR
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LOT COVERAGE m
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LOT SQ FT 9990.00 CD Z
' LOT COVERAGE 32.5% r
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ACTUAL RIDGE HT: 115.65 n
ACTUAL FINISH FLOOR GRADE: 92.40: m
.......... _.. ---
OWNER:
L+O ►: (..14 63 SChL� 20
GOODNIGHT BROS, CONST INC.
R O. BOX 669
FiFlic AIND AD ADDRESS JiC 4 REQUIWo EDMONDS WA• 98020
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