20050672.pdf�• DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
Randel Clifton
MAILING ADDRESS
335 3rd Ave S #202
CITY ZIP TELEPHONE
Edmonds 98020 425-670-8115
NAME
FPERMIT EXPIRES q O
PERMIT
NUMBER
JOB SUITE/APT#
ADDRESS
335 3rd AVe S 202
PLAT NAME•/SUBDIVISION NO. LOT NO. LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApproved ❑
RW Permit Required ❑
Street Use Permit Required ❑
In`spoNoOr Acquired ❑
II y 6 + Sldowd" Requirad ❑
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METr17�.}� UNE,�176..4ti' �a�l�irl��r�6s PR .REQUIRED
YES C� NO O Z
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE _
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NAME CBL##'j 2 through unficated spaces. LIQ C 803.2
Fast Water Heater `"l/7i�Jd ENGINUMN17RMEVVED
ADDRESS .
12601 132 Ave NE
FIRE RE itZ +
CITY ZIP TELEPHONE • . . LL
In addition to the required o
Kirkland 98034 25-814-3124 VARIIpCe6 Yr Ilva 8j# n eojtqMP1SEPA 0
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY TED EXEMPT M
FASTWHC052DF 2-1 6-07 listed ex ansion tank I%N
Q PROPERTY TAX ACCOUNT PARCEL NO. CAN d o{P."h11 h t *0611 Stan EIGHT
00670500020200
SY TUDALLOWED PROPOSED ALLO D PROPOSED
FP'C 08 � v =
RESIDENTIAL LOT COVERAGE REQUIRED SETBACKS (FT.) PR P ETBACKS (FT.) C m
❑ NEW ® ® PLUMBING / MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR M O
�� ❑ COMMERCIAL COMPLIANCE OR z 0
❑ CHANGE OF USE Z C
❑ MIXED USE PARKING LOT AREA PLANNING REVIEWED BY DATE 5 ami C
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REO'D PROVIDED 1L m rn
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❑ REPAIR ❑ GRADING CYDS ❑ FENCE !fl -••I
( X FT.) REMARKS
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❑ DEMOLISH ❑ TANK ❑ OTHER r
Z ❑ CARPFIRE LER
ORT ❑ ROCKERY GE RETAINING WALL ❑ FIRE ALARM
d (TYPE OF USE, BUSINESS ORA TIVITY EIPLAIN 0
TYPE CONS RUC ION CODE OCCUPANT
��—✓i ��� i r GROUP. ll _
wNUMBER NUMBER OF I m m
OF DWELLING SPECIAL INSFECTIOfr CONSULTANT OCCUPANT
pSTORIES ' UNITS I LOAD I O Cl)
-i REQUIRED
DESCRIBE WORK TO BE DONE { O ri1
Rem REMARKS z I i
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garage 4 0. , 0 0 0 btu' S GEOTECH REPORT m i Z
BY: r
STRUCTURAL DESIGN
BY:
61 VALUATION
$
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE. LOT SLOPE% VESTED DATE
Building Permit City Surcharge too
PLAN CHECK NO: Plumbing t A , O 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 Gradin
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g
t SEPARATE PERMISSION.
WPERMIT APPLICATION: SEE ECDC 19.00.005(A)(5) Engr. R@VIEW
a PERMIT LIMIT. SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr• Inspection
•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
M 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
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION -0
Recording Fee Receipt b
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 nota permit until signrxi by the
THE OWNER. 1 AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• CALL Building Official or hislttur Duputy and Fous 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 i5 acMnowledgod ut space provided
WORKMEN'S COMPENSA URANCE AND RCW 16:27, I S31G..T11RE ATE
SIGNATURE (OWNER ORVEN DATE SIGNED (425)
8-3-05 771-U220 RELEA ED BY
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 if IBC1101 IRC110. PINK -OWNER • GOLD • ASSESSOR
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