20050496.pdfDATE RECEIVE.
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
9013F -k-1
MAILING ADDRESS
CITY ZIPTELEPHONE
Nofjis 9�Lo Kz�— � � —zz� 9
NAME
ZIP
PERMIT EXPIRES / f
PERMIT
NUMBERJOBUI
ADDRESS L' Ls'TE/APTa
PLAT NAME/SUBDIVISION NO, LOT NO. LID NO
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApproved O
RW Permit Requited 0
Street Use Permit Roquood 17
EXISTING PROPOSED Inspection Required O
sidewalk Required E3
REQUIRED DEDICATIO14 FT underground O
Wifing required
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES O NO C Z
d
W
REMARKS W
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE z
L9
it
NAME CBL#
f � ENGINEERING REVIEWED BY DATE
IY ADDRESS
U
a FIRE REVIEWED BY DATE W
CITY ZIP TELEPHONE g
0 LL
U
STAT I D
NSE NUMBER EXPIRATION DATE CHECKED BY. VARIANCE OR CU SHORELINE OR ADB# INSPECTION I
REQ�,,,� COMPLETED ED EXEM1P
OYES !7 NO ✓
PROPERTY TAX ACCOUNT PARCEL NO. CA# L40it2 - 32, ZONE SIGN AREA HEIGHT
dx t ' WAIVER E p ALLOWED PROPOSED ALLOWED PROPOSED
LD
0 01 �" 0 v STUDY 13 f' S O NA Z5& Al L,
NEW RESIDENTIAL ❑ PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
COMMERCIAL r" u V ' Zi z
ADDITION COMPLIANCE OR '�o l • I - z Z g 10 • f •• • Zij ,y �'� z
MIXED USE ❑ CHANGE OF USE 3 6 V !�/
PARKING LOTAREA PLANNING REVIEWED BY DATE g
❑ REMODEL
1:1 MULTIFAMILY ❑ SIGN REO'D PROVVIIDDED 14 �p0 ri�ryryle/
GRADING FENCE
❑ REPAIR ElCYDS ❑ X FT.) REMARKS
❑ DEMOLISH ❑ TANK 07HER�j��i
1-s
Z ❑ GARAGE RETAINING CARPORT ❑ ROCKERY WALL ❑ FIRE ALARM FIRE LER
re TYPE OF CO S7U N � GROUP ry r
U
W NUMBER NUMBER OF
G OF DWELLING. SPECIAL INSPECTION CONSULTANT OCCUPANT
M STORIES UNITS LOAD
-792 REQUIRED 13 YES
DESCRIBE WORK TO BE DONE
REMARKS i
O
it L tl:2 1 GEOTECH REPORT m
BY:
r V i` p # T_ f` 0Oki b� r STRUCTURAL DESIGN
BY:
l4-0�i N I��% LTi N VALUATION
1 5 $fq&--
�Buil Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE
Building Permit City Surcharge bw
PLAN CHECK NO: Plumbing Base Fee
i
r� THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC Gradin
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC,) WILL REQUIRE g
J SEPARATE PERMISSION,
Engr. Review
ice Lu
PERMIT APPLICATION: SEE ECDC 19,00.005(A)(5)
a PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) EngL Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
rn
*APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire RBVIeW 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 #
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 S
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 #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEKIS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF This application is 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 COMPENSATION INSURANCE AND RCW 18:27. FFI LS SIGNATUff E
SIGNATURE O NE OR AGENT): DATE SIGNED (425)
\ _
1 i '� ] 771w0220 RE DA
ATTENTION EXT. 133300
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGIN n FILE YELLOW - SPECTO
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109 I IBC110 1 IRC110. PINK - wNER GOLD - ASSESSOR
10104 PRESS HARD = YOU ARE MAKING 4 COPIES
Drawing 1 r- -
Robert Parker Zone �S - i Corner Flamm _.
1045 C Ave. S . C Avenue s Setbacks Required .A�' •�
Zt' V _
Tax # 006494-001-0070 Front ,
[o'
Sides -
i cover plate
Odl
Pow ppl� watcrmeter Undeveloped road right -of way APPROVED RV
• 1 Y.i
( O`
[mpervious surface calc.data G Zoi✓ — t.
Existing bldg area = 2532 sf 120 ft
Existing prch = 16sf +105' +109
M, :.
Existing driveway,etc = 170 f 4
• . !�� • �� • • ':
Existing paths 203sf - - - "` _ _�M. • ?
Proposed deck additions = 1 Ssfr' rn;
S a C
M
26 Fr 0 P
• t' �. _ _ _.... ._.___ - " "• _.. _� +113• Q
` ,r j, existing deck over ®- pmposod deck aJdition
r Concrete patio
+1 to be repgireZ7replace N }
lit anngoo�v X115 l r.
r r�
to 4eFt e H (s
a x N s
n[...29 Fr. ng +119m rnv
Rockery O N i
ft CN1
. 1Pi