20050873.pdfr
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAAIEINAME OF BU (NESS
ftf r low a
It MAIW.NGADDRf SS r
q0 Ica,
CITY ZIPTELE PHONE
C�61 cZ5o23�.
NAME
U
Z� PERMIT EXPIRES
PERMIT ,�, --�
NUMBERJOB-CJ�
ADDRESS __ l� bo I e _1 v l/�., n�-.� � lk� � TEIAPTa
PLAT NAMEISUBDIVISION NO. LOT NO.. � LID N
LID F S
O
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP 7ESCP ApprovalRW Permit Re(tUUed 0
PRIM d SPLFPTION REQUIRED Street use PermnRequired
O
EXISTING, _ Inspection Roquded E3
c Sidewalk Required
REQUIRED dblcSTi9EET TO I1UF-QL ' 1 ' rts a0
METER S% IDt W5VER M"FlfffTURE is t/SCC] D11REQUIRED 0
Z
OPERT X Ll E W
REMARKS w
OWNER1COt6RACV0ATWNrqffigM E!f0SIWW f z
R 0 1 / N Vl� t1USE BIB, WITH A b INSTALLED W
Y ZIP ITELEPHONE
/�)Ickfyd 0"11.0%3 q3 64
UMP AT APPROVED DUMP SITE ONLY
NAME C 1 EI i-o,'%Ini rrl' N INSPPCTION
Scc 2 c i 6 C- GV J10 1 ;
r✓ �"� ENGINEERING RE��/����yyyy D YQ "J,;,
f LJJ� IlVat �. t ti ,v �..+ '1:.. .i-ry L
U
cc ADI FIRE REVIEWED BY DATE ly
ZU` ,'•r•�1 l I _TIC, cn„nur
L,3-753
STATE Llrcruc kn rklocC FXpIRATInN ATF CHECKED BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
�� • O �� - I ��O REQ'D COMPLETED EXEMPTIC YES 13 NO
CA# ZONE SIGN AREA HEIGHT
FIXPROPERTY TAX ACCOU T PARCEL N0. ALLOWED PROPOSED ALLOWED PROPOSED
� Orr,� WAIVER
V �./tJ O� 1 ✓ STUDY iD
❑ NEW RESIDENTIAL ❑ PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR O
COMMERCIAL COMPLIANCE OR z
❑ ADDITION El CHANGE OF USE z
❑ IXED USE PARKING LOT AREA PLANNING REVIEWED BY DATE 5
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REQ'D PROVIDED
❑❑GRADING ❑ FENCE
REPAIR CYDS X FT.) REMARKS
DEMOLISH ❑ TANK ❑ OTHER
GARAGE _ ❑ CARPORT ❑ ROCKERY IWALL LER
G ❑ FIRE ALARM
a(TYPE OF USE, BUSIN SS OR ACTIVITY) EXPLAIN:
� TY CONS UCTION CODE OCCUPANT
v GROUP
oNUMBER NUMBER OF
OF DWELLING SPECIAL. INSPECTION CONSULTANT OCCUPANT
O STORIES I UNITS LOAD
-1 REQUIRED 0 YES
DESCRIBE WORK TO BE DONE'
REMARKS, z
aa)nD
GEOTECH REPORT
m
r BY:
STRUCTURAL DESIGN
BY:
VALUATION
L Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE
Building Permit $ C City Surcharge
PLAN CHECK NO: /,� �Plumbing 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
SEPARATE PERMISSION, Engf, Review
W
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 Chk. Deposit
Lu
Lu IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
a 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.'
Recording Fee I It 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 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 hislher Deputy: and Fees 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 recei is acknowl�dged in space provided.
WORKMEN'S COMPEN N SURANCE AND RCW 18:27, PR SI A URE / DATE
SIGNATURE (OWNER OR GENT): DATE SIGNED (425)
' ! 771 -0220 ED Y l• r DATE V
ATTE ON4 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. UBC1091 IBC110 1 MCI% PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD w YOU ARE MAKING 4 COPIES
Z
0
M
CO)_
C
M
O
MA On
=z
mZ
Q
C Z
r M
CA
mn
mrn_
o �
r
K 1
74f
r
—1
2
Z
t 410101111
co_
Z
O
0
m