20050695.pdfDATE RECEIVEQ��
�C� PERMIT EXPIRES =001
PERMIT
CITY OF EDMONDS ZONE NUMBER Ut —
CONSTRUCTION PERMIT APPLICATION
JOB
U 01 3rd I E/APTN
Uu
OW ER NAME/NAME OF BUSINQSS
5\1
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
lJ i �J �J ( 1 j� �� LID FEE S
MAILING ADDRESS TESCIP
L(or+ 13
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP AW Permit Required [j
Street Use Permit Roq'd E3
EXISTING PROPOSED inspection Required O
CITY G Q 1ZIIPJ� TELEPHONE u Sidewalk Required p
I �J REQUIRED DEDICATION Wiring Underground
WMnpround
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES ❑ NO ❑ Z
w
ADDRESS REMARKS =
OWNER/CONTRACTOR RESPONSI tf4911 R ION CONTROL/DRAINAGE
�.lVitinorIAL
CITYZIP TELEPHONE MUST RWPQEN:F FOR
t ANK FILL,
CBLq
NAME ` (
uc� �—^-' t `' NrL'� a 1 tul ENGINEERING REVIEWED BY DATE
ADDRESS
PCC) ��x x122 8
FIRE REVIEWED BY DATE �
CITY zip
ZIP TELEPHONE LL
'��� ZC�� a)q VARIANCE OR CLI SHORELINE OR ADEN INSPECTION BOND
STATE LICENSE NUMBERR. EXPIRATION DATEY REO'D POSTED
(Pq
0S OYES ONO g
SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT
PARCEL fNO. j� COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
QO Z2 6000 ! �w EXP
❑ NEW RESIDENTIAL ❑
PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
COMPLIANCE OR
❑ ADDITION ❑ COMMERCIAL❑ CHANGE OF USE Z
11 PARKING LOT AREA PLANNING REVIEWED BY DATE CL5
❑ REMODEL 1:1 SIGN ❑ SIGN REO'D PROVIDED
E:] REPAIR ❑ GRADING ❑ PENCE coos X FT) REMARKS
❑ ❑ DEMOLISH � TANK OTHER
GARAGE FIRE
NING
SPRINK
❑ CARPORT ❑ R CKIERY WALL ❑ FIRE ALARM LER
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: ( CHECKED BY TYPE=TRT 7CM OCCUP/�fjO I U T� (� 0 W wj b� 1" vl J A GROUP/`/
NUMBER NUMBER OF CRITICAL OCCUPANT
OF DWELLING ` AREAS SPECIAL INSPECTION AREA LOAD
STORIES UNITS NUMBER REQUIRED ❑ YES
DESCRIBE WORK TO BE DONEREMARKS
t7
�L�"� �� � ���'�`f��N� PROGRESS INSPECTIONS PER UBC 10811BC109/IRC109 FlNALINSPECTION REa'D 9
PUMP,,
'm
L Low C71c.P1" [5 O&� 6 Ksb VALUATION
Q+j4(0 Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Cj I
Building Permit tY Qurchar
e 9 ` r D
PLAN CHECK NO: VESTED DATE Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
C BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
7 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
3 SEPARATE PERMISSION.
Engr, Review
W PERMIT APPLICATION: 180 DAYS
a PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr: Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
•APPLICANT• ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
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 k
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscape Insp. Total Amt. Due
9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE �7
Y NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.0 f
Recording Fee Receipt N
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 o permit until signed by the
THE OWNER. I AGREE TO COMPLY WITIi. CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building ONicinl or his/her Deputy: and Foes are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED FOR INSPECTION receipt is acknowledged In space provided.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. C O \CIALSc GNATW TE
SIG ATURE (OWN R O AGENT) DATE SIGNED (425)
65 771-0220D RELEASE Y E
ATTENTION EXT 1333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORACERTIFICATEOFOCCU- ORIGINAL - FILE • YELLOW -INSPECTOR
PANCY HAS BEEN GRANTED, UBC109 / IBC110 / IRC110' PINK -OWNER GOLD - ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
M
0
0
M
�m
_
cM
m�
O
O
n
C.
mZ
p
D
Z
r
-1