20050648.pdf4
DATE RECEIVED
PERMIT EXPIRES 1
CITY OF EDMONDS PERMIT R
CONSTRUCTION PERMIT APPLICATION JOB ADDRESS �+ ��` UITE/Ar
O E NAM /NAME OF B SINES / !
PLAT NAMEISUBDIVISION NO. LOT NO LID NO.
ZZ?W M ILIN AADDDRESS / / 11 \ LID FEE S
o TL 0) ❑ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved RW Permit Required ❑
CITY ZIP 1 ELEPHONE EXISTING PRO�O Street Use Pormd Required ❑
' ►ASPin TEST MUST 'CHI
Roquur•tl ❑
Ik Required ❑
REQUIRED DEDICATIO tl round ❑
a ❑
NAME METER SIZE F IX EOUIRED
AFFIDA ITS SHALL N TES ElNO o z
t ADDRESS REMARKS�(� W
OW ER/CONTRACTOR RESPONSIIU24COM LIifiOUDRAINAGE
at z
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CITY ZIP TELEPHONE
N ME CBL# Ay
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0 AD RE l ENGINEERI G REVIEWEDBY
througu�tlicated spaces, Y1VFL�303.2
FIRE REVIEWED BY DATE w
z CITY ZIP , TELEq ONE p
`57ATE LIGENS NUMBER EXPIRATION D E ECKED BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
� ((� REO'D COMPLETED EXEMPTI� YES ONO
a PROPERTY TAX ACCOUNT PARCEL NO.
CA# ZONE SIGN AREA HEIGHT
W �� L '�L 6� �% WAIVER 0 ALLOWED PROPOSED ALLOWED PROPOSED
o f l STUDY O
❑ NEW IDENTIAL PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
❑ ADDITION ❑ COMMERCIAL ❑ COMPLIANCE OR 0
❑ z
MIXED USE CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY DATE g
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REO'D PROVIDED a
❑ REPAIR ❑ GRADING CYDS ❑ (ENCE X FT.) REMARKS
❑ DEMOLISH ❑ TANK ❑ OTHER
z ❑ GARAGE CARPORT ElROCKERY NING WALL ❑ FIREALARM FIRE SPRINKLER
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
Cpp OCCUPANT
/\'n GROUP P
tuu NUMBER NUMBER OF C 1
OF DWELLING SPECIAL INSPECTION CONSULTANT . OCCUPANT
p STORIES UNITS LOAD
DESCRIBE WORK TO BE D NE REQUIRED YES
REMARKS
z
cwG[OTECH REPORT �
—r BY: m
STRUCTURAL DESIGN
BY:
I VALUATION.
U� . $
of Description FEE Description FEE
Plan Check State Surcharge
HEAT SPUFTCE LOT SL PE% NVESTED DATE
Building Permit City Surcharge 1
PLAN CHECK NO: Plumbing C> Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO Mechanical
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
t: SEPARATE PERMISSION.
a Engr. Review
lz w PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
a PERMIT LIMIT: SEE ECDC 19.00,005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
•APPLICANT, ON BEHALF OF HIS Oa HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
Uj IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 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
s 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 #
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 Is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy: and Foes are paid, and
IN VIOLATION OF THg LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPEN ATIO URANCE AND RCW 18:27.
OF kL GNATUR V� ATE
SIG TU E WNER GE \ DATE SIG EO (425� rt ��
1 _bs�
77122
'0220 RELEASE BY i DATE
ATfENTI6 I EXT. 1333
IT IS UNLAWFUL T USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
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DATE RECEIVED
PERMIT EXPIRES 1
CITY OF EDMONDS PERMIT R
CONSTRUCTION PERMIT APPLICATION JOB ADDRESS �+ ��` UITE/Ar
O E NAM /NAME OF B SINES / !
PLAT NAMEISUBDIVISION NO. LOT NO LID NO.
ZZ?W M ILIN AADDDRESS / / 11 \ LID FEE S
o TL 0) ❑ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved RW Permit Required ❑
CITY ZIP 1 ELEPHONE EXISTING PRO�O Street Use Pormd Required ❑
' ►ASPin TEST MUST 'CHI
Roquur•tl ❑
Ik Required ❑
REQUIRED DEDICATIO tl round ❑
a ❑
NAME METER SIZE F IX EOUIRED
AFFIDA ITS SHALL N TES ElNO o z
t ADDRESS REMARKS�(� W
OW ER/CONTRACTOR RESPONSIIU24COM LIifiOUDRAINAGE
at z
w
CITY ZIP TELEPHONE
N ME CBL# Ay
f^
f4jel.hittaning Rpliliances passing
0 AD RE l ENGINEERI G REVIEWEDBY
througu�tlicated spaces, Y1VFL�303.2
FIRE REVIEWED BY DATE w
z CITY ZIP , TELEq ONE p
`57ATE LIGENS NUMBER EXPIRATION D E ECKED BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
� ((� REO'D COMPLETED EXEMPTI� YES ONO
a PROPERTY TAX ACCOUNT PARCEL NO.
CA# ZONE SIGN AREA HEIGHT
W �� L '�L 6� �% WAIVER 0 ALLOWED PROPOSED ALLOWED PROPOSED
o f l STUDY O
❑ NEW IDENTIAL PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
❑ ADDITION ❑ COMMERCIAL ❑ COMPLIANCE OR 0
❑ z
MIXED USE CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY DATE g
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REO'D PROVIDED a
❑ REPAIR ❑ GRADING CYDS ❑ (ENCE X FT.) REMARKS
❑ DEMOLISH ❑ TANK ❑ OTHER
z ❑ GARAGE CARPORT ElROCKERY NING WALL ❑ FIREALARM FIRE SPRINKLER
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
Cpp OCCUPANT
/\'n GROUP P
tuu NUMBER NUMBER OF C 1
OF DWELLING SPECIAL INSPECTION CONSULTANT . OCCUPANT
p STORIES UNITS LOAD
DESCRIBE WORK TO BE D NE REQUIRED YES
REMARKS
z
cwG[OTECH REPORT �
—r BY: m
STRUCTURAL DESIGN
BY:
I VALUATION.
U� . $
of Description FEE Description FEE
Plan Check State Surcharge
HEAT SPUFTCE LOT SL PE% NVESTED DATE
Building Permit City Surcharge 1
PLAN CHECK NO: Plumbing C> Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO Mechanical
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
t: SEPARATE PERMISSION.
a Engr. Review
lz w PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
a PERMIT LIMIT: SEE ECDC 19.00,005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
•APPLICANT, ON BEHALF OF HIS Oa HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
Uj IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 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
s 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 #
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 Is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy: and Foes are paid, and
IN VIOLATION OF THg LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPEN ATIO URANCE AND RCW 18:27.
OF kL GNATUR V� ATE
SIG TU E WNER GE \ DATE SIG EO (425� rt ��
1 _bs�
77122
'0220 RELEASE BY i DATE
ATfENTI6 I EXT. 1333
IT IS UNLAWFUL T USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
-. 11Ar M1E?11T\1 ■AAMC AMM AnnnA\/AI e%M A /`411=f1T1
z
rn
cM
v
�o
O
_ K
m Z
g)
C Z
r— —I
W
O
2 �+
rnm
n
O r.
nr
rn
K�
i Z r
D
f z
-1
2
z
O
"I
n
rn