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20050571A.pdfI GATE RECEIVED!� CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION R NAME/NAME OF BUSINESS q7e h/IL 4 � MAILING ADDRESSn Zr CITY ZIP I TELEPHONE NAME CB # ILK ADDRESS PERMIT EXPIRES V7,i PERMIT NUMBER JOB SUITE/APT# ADDRESS ' PLAT NAMEISUB DIVISION NO. LOT NO. LID NO. LID FEE $ . PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TE Permit equi ❑ RW Permit Required ❑ Street Use Permit Required ❑ EXISTING PROPOSED inspection Required ❑ Sidewalk Required ❑ REQUIRED DEDICATION --pY""' " ' w underground E3,•....� a ueed ❑ MEIR SIZE LI f S R REQUIRED Obta rt dEtr a triesYES. NO O z W REMA K M ILU' j a'1 W OWNE IC NTRACTOR RESPONSWLF,�R6eMMCOMAbL/DRAINAGE z �. z f""""�" ` s rc wired. a apPlianCCS passing Imc titirntip-ih unheated spaces. FIRE REVIEWED BY DATE DATE CITY .21P TELEPHONE STATE LICENSE NUMBER EXPIRATION DATE ECKED BY VARIAN CU ,SHOR N ON E �► 7 d. I In add tion` r�> T ' PROPERTYTA ACCOUNTPARCELNO. CA# N . S Ifta HEI ,� v WAIVER O `1Ste expansl L�� PROP os D �nnt�OWED STUDY O hOt► ted K3• ❑ NEW RESIDENTIAL PLUMBING / MECH AL LOT C �E-2EOONT SETBACKS (FT.) PROPOSED SET ALLOWED f�'SEO�j �� FRONT SIDE RE COMMERCIAL COMPLIANCE OR ��p ^n om ❑ ADDITION ❑ '" . - ..: ❑ MIXED USE CHANGE OF USE ❑ REMODEL ❑ PARKING LOT AREA PLANNING REVIEWED BY DATE MULTIFAMILY ❑ SIGN REQ'D PROVIDED GRADING FENCE ❑ REPAIR ❑ CYDS ❑ ( X FT.) REMARKS ❑ DEMOLISH ❑ .TANK ❑ OTHER GARAGE RETAINING ❑ WALL FIRE CARPORT ❑ ROCKERY FIREALLER ARM OCCUPANT GROUP W rL EXEMPT IT PROPOSED ,CKS (FT.) REAR z z z z 5 NUMBER NUMBER OF OF DWELLING SPECIAL INSPECTION CONSUL OCCUPANT STORIES UNITS REQUIRED YES LOAD DESCRIBE WORK TO BE DONE REMARKS z j_ Iar� GEOTECH REPORT r BY: a0 G7� U STRUCTURAL DESIGN BY: VALUATION $ l�2r l Description FEE Description FEE Plan Check State Surcharge HEAT SOUR SjE LOT SLOPE% VESTED DATE Building Permit City Surcharge PLAA CHECK NO: d Plumbing Base Fee 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 J SEPARATE PERMISSION. rt Engr. Review U PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5) L PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) SEE BACK OF PINK PERMIT FOR MORE INFORMATIONMISSION Ellgf. inspection r� 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit Aj IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF Y 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 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due 0 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 APP OVAL GIVEN IS 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 hlslhor Deputy: and Fees 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 I cknowledged in space provided. WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27. IALS ATU DATE SIGNAT (OWNER R ENTj,� DATE(425)•�SI NED 771 -0220 RELEASE BY ATE AftS1tNTION EXT. 1333 or IT IS UNLAWFUL TO USE OR OC U Y 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, UBC109I IBC110I IRC110. PINK -OWNER • GOLD . ASSESSOR 10104 PRESS HARD - YOU ARE MAKING 4 COPIES