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20050521.pdf+� DATE RECEIVED / i Z Li =PERMITPIRES �z 7 PERMIT CITY OF EDMONDS NUMBER a �cSd CONSTRUCTION PERMIT APPLICATION JOB / SUITEIAPTP ADDRESS 1 .�� l� l SR NAMEINAME OF BUSINESS P1 j'' PAT NAME/SUBDIVISION NO. LOT NO. LID NO. MAILING ADDRESS -^- •_�••�•••.r.,..._ •, LID FEE $ uj Z PUBLIC RIG 'T .li , C L T V A av{s�pyq�l{q� a gfl tee+ �►§fti '��ntlt'cto 5 A Tt1fFl FF1:6 ion Fuel 1r ' a CITY 1 ZIP TELEPHONE EXISTING _! On �pQ_*tea krOpCr n FoQu:roa }}��• Ugh Y`� JbiL Requuen O REQUIRED FDICA�11er�!—U�tL't i a'ZF�r— rr 'na O NAME METER SIZE LINE `•-� fatf'6Ffliii V REQUIRE F YES O NO O b U K t ADDRESS REMARKS W W u OWNER/C NTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE Z e .n cl _ 1 _ _ 1 / w ,W �Vv�+ y I 1C� L' ENGINEERING REVIEWED B T?UR.SUANTrTOjTPC DATE a ADDRESS 1 ApMS(1RF.REGULATORVALVE(PRV) U 2- o '�MiCq`66 >� FIRE REVIEWED BY ' DATE z CI ZIP TELEPHONE T 3.r~ WATERSgILMFF JOCU STATE LICENSE NUMBER EXPIRATI DTE Cf ECKED BY VARIANCE OR Cu SHORELINE OR ADB# INSPECTION SEPA 8 E �, YREQ'D COMPLETED EXEMPT cull I � g i Baa rU� fuQ a PROPERTY TAX AcCCOU T PARCEL NO. WAIVERE3 SERVEq A[i�(�'w(E:C "Df�EN EC7bIKPROPOSED STUDY 13 AFFI® VI 1 V ❑ NEW RESIDEWTIAL PLUMBING'/ MECH LOT COVERAGE REQUIR EA � % ROPOSED SETBACKS (FT.) ALLOWED PROPOSED FRON I ONT UR SIDE REAR COMMERCIAL COMPLIANCE OR ❑ ADDITION N❑ CHANGE OF USE i ❑ MIXED USE PARKING LOT AREA PLANNING REVIEWED BY DATE g ❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REQ'D PROVIDED ❑ GRADING FENCE REPAIR. ❑ CYDS ❑ ( X FT.) REMARKS ❑ DEMOLISH ❑ TANK ❑ OTHER Z ❑ GARAGE RETAINING SPRINKLER CARPORT ❑ ROCKERY WALL ❑ FIRE ARM a(TYPE OFU E, B SINESS OR ACTIVITY) EXPLAIN: i C TY ON,STRU ON CODE. GROUPOCCUPn v J r r U Vt,%tl h w NUMBER NUMBER OF G OF�i DWELLING SPECIAL INSPECTION CONSULTANT. OCCUPANT O STORIES v UNITS 1LOAD REQUIRED C] YES DESCRIBE WORK TO BE DONE REMARKS z %,,h Azd1irin v PcD<al GEOTECH REPORT _ m BY: rQ ( Cl 14 5 1 1,601 STRUCTURAL DESIGN Z CSZ)�� ` S , f� VALUATION /0 6 L k F $ bl 4/�t Description FEE Description FEE .KQ do J. Plan Check State Surcharge HEAT SOYRCE LOT.SL ° • ff VPSTE DATE / t V .Building Permit City Surcharge PLA CHECKQ: Plumbing LBase Fee `5 Ove 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 SEPARATE PERMISSION. tEngr. Review w 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 rq '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 Z' EDMOND% WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt # i ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE 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 # !L 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 1s not a permit until signed by the THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building Official or n is or a ui and Foes are paid, and TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowled d in space provided WORKMEN'S COMPENSA SURANCE AND RCW 18:27. %IAL GNAT E ATE 4 SIGN /R,E�A(OW�N. GE T): DTE GNED (425)n (J� 17)"wLL- ! a 771 '0220 RELEA E B DATE J ATTENTION 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 I IBC110 1 IRC110o PINK • OWNER • GOLD ASSESSOR 10104 PRESS HARD = YOU ARE MAKING 4 COPIES i i i O m' —i -n C rn rn �O Oc =A C =m M Z p -1 DZ r= O MM O� r m r M n Mrrn D s D Z 0) O ami LLL ,il.