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20050599.pdfDATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAME/NAME OF BUSINESS w MAILING ADDRESS CITY t1 f ZIP TEjjLE�PH`ONE 1J M In NAME ZIP ITELEPHONE J ^ PERMIT EXPIRES ' PERMIT r\ NUMBER C J J V�`' JOB/ SUITF�APT# ADDRESS 201.1/ ��f II\��..';J / All P. PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP IESCP Approved RW Permit Required Street Use Permit Requited. EXISTING PROPOSED Inspection Required Sidewalk Requeod 91 REQUIRED DEDICATION •� FT Undorground Witing required METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED +i ( YES O NO [3 z tz W REMARKS w OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE z 10z s NAME Glow %D.�--eAt—Ctct., l1Y U C�" • ENGINEERING REVIEWED BY DATE, 0 ADDRESS •' �J-� r�© U NC EW FIRE REVIEWED BY DATE ru zC IY\ ZIP TELEPHONE I Ir 1111A= a L Ot Gj( STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION ISEPA REO'D�� COMPLETED EXEMPT d - a YES I;rNO DM VI' -'PROPERTY TAX ACCOUNT PARCEL NO. CA# 9 zj - Id7 ZONE SIGN AREA HEIGHT 4 WAIVER Gr ALLOWED PROPOSED ALLOWED PROPOSED U) tlp�W jury l/ 1\ � l/ D STUDY O P� 4 Z j r Z >� � NEW ,�`� RESIDENTIAL PLUMBING 1 MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) ` ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR t7 ❑ COMMERCIAL2:0COMPLIANCE OR ��7o Z0• r�ZO 4L ��.5 z El ADDITION ❑ MIXED USE ❑ CHANGE OF USE #0 z PARKING LOTAREA PLANNING REVIEWED BY DATE g ❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REQ'D PROVIDED n i FENCE 2 Z �� /G� 9� ��Z�i�✓� ❑ REPAIR 19 G�D C'[y CYDS ❑ _4.6.� ( X FT.) REMARKS ❑ DEMOLISH ❑ TANK ❑ OTHER GARAGE RETAINING WALL FIRE SPRINKLER z CARPORT ❑ ROCKERY ❑ FIRE ALARM (TYPE OFUSE, BUSINESS j�ACTIVITY) (1 \ r ! TYPE' C TRUCTION E GROUP e' U GNUMBER NUMBER OF OF DWELLING ' SPECIAL INSPECTION CONSULTANT OCCUPANT p � STORIES UNITS �.�� LOAD REQUIRED. D YES DESCRIBE WORK TO BE DONE REMARKS i GEOTECH REPORT m BY: Sl'R U L DESI VALUATION $ r` f kJ 2 Description. FEE Description FEE Plan Check Stale Surcharge HEAT SOURCE LOT SLOPE% VESTED DATE fid �j w Building Permit s City Surcharge PLAN CHECK NO: Plumbing Base Fee . L /� �0 THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBIC DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE trading iSEPARATE PERMISSION. Engr. Review IY LPERMIT APPLICATION: SEE ECDC 19.00.005(A)(5) wa PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) •` SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection rn *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 M EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt # 4 ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE; ARISING DIRECTLY OR INDIRECTLY = FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE j o DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape lnsp. Total Amt, Due = NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' Recording Fee Receipt # �7 1 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 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 Foos are paid. and TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CO OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged et space provided. WORKMEN'S SATION YiSUPNCE AND RCW 18:27. SIGNED TS SIGNAT 1 E DAT SIGRE OWNER R N DATE S / (425) I ~ !� �OS 771 -0220 R B DATE 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- IGINAL I E • YELLOW • INSPECTOR FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 ifIBC110 / IRC110. ' PINK -OWNER • GOLD - ASSESSOR 10104 PRESS HARD - YOU ARE MAKING 4 COPIES 0 m m nm r Z n rw2 Z r CD I z O i n m r 0 m -� " n Cn c im my O -� On C mm Z p � C Z r = 0 m m nm r Z n rw2 Z r CD I z O i n m RIGHT-0t•-WAY C( S T RUG i ION PERM1 i AND INSPECTION REQUIRED + N ACCEPTABLE TIGHM-114 z i m T , .,If Lim [L I 1 Ise —pl5 NO--TE-DSDR 35 I N - — -- — `— ` E-CSCH 40 I 12 N j l b I r .>„-.1 •, A. r_ t—RNG T , `` , y I ,--ll ...,... \ i a , I -c' • - N'•'0 MI"iF.R I`, I I V(�`ti. ,..••-••••r n; • „ 1 J It i r._ _- �}---:�' RE5IDENGG ,u OF Vpi"I l FIDCR • in 1 IQ I 'i .I 1 .. /ENJE m i WATER`, �^ _a'I SEWRt .. y: , > �;a �,.., — INSP 'RE P . I- /� ip,� i au EC py %' ` iLE �` , • r ^ 13ON`")[��1—� I I I 11If� 1 Riff i 1�I I li I . l j i j�7 i l� l `i N 1 CAU 425-771,8220 ET ,� ..6 ; �' r�� i�.11 , Ii�dt� D,1tlr�: �. ,:, ..11 r.- . LOPE '• ! ' v �—� T— -- -- ---, — - - rAT10 „ S�Ivi Gr�IVEWAYI I.. �,LppROX. 5S. LOGATIOH Pdt ALLOWED-44% I Ilc -.1 pUT,p(LKAEOJt y OF E�10td'I P VIII DEPT• _ _ j �, i I � / I 17.0, \ 9'-b i'LII• ,�, Q•'6 � j � 1' `I � . s i - ' �,,- T�1 •'�� 1Fi-0 ij��-X16--0���1 1 ,/ \ - � . i . �•• -I-^ , i i L^EA"�JGT1NSGhi.ODOR;An'Ll(. �� � .�RI t l ipG-f ptI•C.OfI/11•Elt _ /y6\\l'��CJJ`7i&i-T•LI[L.i 4 ` . « � y, O"IECT CIG& SIDEWALK FORM i .ly�'VV - t t ' — INSPECTION REQUIRED.. NTNG) t 4 INSPE o ___ I �ir TOP: lob-211 'Gg I ��1w+�-!,po:T►14 wora®aY1 !1� TOF'. IOb 00 I.L. ;�X�iST 4 IE. IDT/�D t'✓I _ ~�U4CkM� � bF (NCr1 1 Fr+ UOT NTri� .o.F lob a DIP (5) 100.01 1 cKgr .I Z 1 E•'pp fSl b" � SMODTH � ty�i GCMIEG. ALL 5D W'[�btkt'(u TO LINE / ,-1 Do,w•sPGvrS ro carr Ga t -�zl i G3 ® 1 i • V . T/Tf W/6" d 5t 1D07N TISHT-LNt : N ! 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