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20050728 (2).pdfADATE RECEIVED 0 ` PERMIT EXPIRES a ZL CITY OF EDMONDS NUMBER CONSTRUCTION PERMIT APPLICATION DRESS _ _ niro �2a0�,� fin S� OWNER NAMEINAME OF BUSINE/nS�S Ci l I `7 o AA- o P& S t> �� L r- PLAT NAMEISUBDIVISION NO. LOT NO. LID NO. Lu MAILING ADDRESS LID FEE 5 z C �% �j� PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved ❑ G �V (�OL.V S1. 10,1D [L l RW Permit Required ❑ Strew Use Permit Required CITY ZIP TELEPHONE +/� �If /%�rC� /�/ EXISTING PROPOSED Inspection RequirediSLiJ / {Jc V ! 1 /, / ! V `. SWewyk Required p rr� Q , REQUIRED DEDICATION -�'' FT underground irinr required ❑ NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED u ' YES 0 NO O z W t ADDRESS REMARKS OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE z az A_ n ...� _ 1 .n .. _ W .. fGC. jhj NAME t L, / L/ CBL# �` / L V /" 1 ENGINEERING REVIEWED BY 1 DATE IZ ADDRESS ' 1 /n C."'V 9 5t 51.E Sim D N IE { (,( FIRE REVIEWED BY DATE CITY ZIP TELEPHONE it O oe g8dC�� 3, �s LL TA E LICENSE NUMBER EXPIRAT ON DATE C CKED BY VARIANCE OR CU SHORELINE OR ADB# I INSPECTION SEPA � oO��� �"• � REO'D COMPLETED EXEMP�Tt At)U YES N OSO V -f PROPERTY TAX ACCOUNT PARCEL NO. CA# ZONE SIGN AREA HEIGHT W �`� 2� O� /O� WAIVER A ALLOWED PROPOSED ALL PROPOSED R7 0 J STUDY ❑ NEW ❑ RESIDENTIAL ❑ PLUMBING / MECH LOT COVERAGE REQUIRED S TB CKS (FT.) PROPOSED SETBACKS (FT.) ��( ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR f{(I COMMERCIAL COMPLIANCE OR l ' ? ❑ ADDITION 4 ❑ CHANGE OF USE G � ` f w Z ❑ MIXED USE. PARKINGLOT AREA PLANNING REVI WED BY DATE g ElREMODEL ❑ MULTIFAMILY �1SIGN REO'D PROVIDED C l,II ❑ REPAIR ❑ GRADING CYDS ❑ FENCE ( X FT.) REMARKS ❑ DEMOLISH ❑ TANK 1:1 110 M b » ` V7 O z El CARPORT ❑ ROCKERY GARAGE RETAINING WALL ❑ FFIRE IRE ALARM LER �10 W 44&0 "� ��� W O a (TYPE OF SE, BUE S OR ACTIVITY) XQAINJ: oVVVC` TYPF�CO`` ION K s C OCCUPANT U GROUP Lu NUMBER NUMBER OF 1 OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT I o STORIES UNITS 7LOAD DESCRIB RK TO BE DONE REQUIRED YES REMARKS L9 LL 1,ok) 40P S/6/YS rel( _ 0 GEOTECH REPORT K/D/t / r� / K✓D[J BY: m STRUCTURAL DESIGN ? L4r VALUATION © $ ✓ �tf Description FEE Description FEE Plan Check18V State Surcharge HEAT SOURCE LOT SLOPE% VESTED DATE/ Building Permit 0 City Surcharge ' PLAN CHECK NO: Plumbing Base Fee THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO THIS t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC,) WILL REQUIRE Grading t SEPARATE PERMISSION, aEngr. Review w PERMIT APPLICATION: SEE ECDC 19.00,005(A)(5) 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 Chic. Deposit Duo v0 IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF q� EDM NDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt # O �� 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 V 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 APPROVAL GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF THE OWNER. 1 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 THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided. WORKMEN'S COMPENSATION I URANCE AND RCW 18:27. "-0 FICI SIGNATURE /( DATE TUR OWNER 0121 Zia DATE SIGNED (425) ( Z)5' - 771 0220 ELE 0 U DATE V✓ ATTENTION EXT. 1333 )fj IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND. APPROVAL OR A CERTI- FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109 / IBC110 / IRC110. PI A • FILEOG LOW -INSPECTOR P-OWNERLD •ASSESSOR 10104 PRESS HARD - YOU ARE MAKING 4 COPIES r Z 0 M =i 'n cM M0 -i0 O 0 mZ 10 Dz r= 0 mn mn mm_ 0� r M r mN i Zrrn D X D i z 2 Z 0 M