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20050874 (2).pdfDATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION 77/7714aleel NAME OF USINESSL4alllllow�' /l MAILING ADDRESS CITY ZIP TELEPHONE NAME % '— L FPERMIT EXPIRES PERMIT --�0 �- NUMBER JOBADDRESS I O ! \ �\ \ �EIAPT# � PLAT NAME/SUBDIVISION NO. f LOT NO. LID NO. LID FEE 5 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApproved O RW Permit Requited E3 Street Use Permit Required E3 EXISTING PROPOSED Inspection Required 0 — .,.w....�� o REQUI ( 'btE61C%iTIONTs • Vs�w FT j - undTM &yrgrou eA! nf%niyrr�& itsd O MEfi4 S E LINIr SIZE NO. OF FIXTURES PRV RE UIRED loll file - ;31,tiraccs passln} ` NOC3 REMA ' W OWNrLRIGONIRAGTOR•RESPONSIBI.-E EROSteN'COMTROM YITATRAME _ O z W NAMt J'Ac' 6LI �/ � `� • "" 4/Vc ENGINEERING REVIEWED BY DATE z ADDRESS -7 J FIRE REVIEWED BY DATE u CITY ZIP TELEPHONE ° STATE LICENSE NUMBER EXPIRATI N DATE CTV VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA �����41o1 DREO'D COMPLETED EXEMPT STATE LICENSE NUMBER EXPIRAT&N DATE C• OYES D NO PROPERTY TAX ACCOUNT PARCEL NO. CA# ZONE SIGN AREA HEIGHT Q /, WAIVER 13 ALLOWED PROPOSED ALLOWED PROPOSED � . O 70V STUDY O ❑ NEW ESIDENTIAL PLUMBIN/ MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR t COMMERCIAL COMPLIANCE OR ❑ ADDITION ❑ MIXED USE CHANGE OF USE i ❑❑ SIGN REO'D ARPIROVIDED LOT AREA PLANNING REVIEWED BY DATE REMODEL MULTIFAMILY FENCE ❑ REPAIR GRADING CYDS ❑ ( X FT.) REMARKS ❑ DEMOLISH ❑ TANK ❑ .OTHER z ❑ GARAGE CARPORT 13RKIERY NING WALL ❑ FIRE ALARM FIRE LER P: (TYPE OF USE, BUSINESS QR ACTIVIJY) EXPLAI A _ NUMBER NUMBER OF OF DWELLING SPECIAL INSPECTION CONSULTANT OCCU j .STORIES - UN TS - LOAD s REQUIRED D YES - DESCRIBE WORK TO BE DONE REMARKS / `'� `/ �i GEOTECH REPORT BY: STRUCTURAL DESIGN BY: VALUATION . $ :J6 CA" ItLJL Description FEE Description FEE Plan Check State Surcharge HEAT SOUR E LOT SLOPE% VESTED DATE Building Permit City Surcharge zo PLAN ECK 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 : DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading SEPARATE PERMISSION. Engr. Review w PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5) CL PERMIT LIMIT: SEE ECDC 19,00.005(A)(6) SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection eN) *APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit Lu IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF C EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection LReceipt# ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY = FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE CDEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE LandscapeInsp. t. Due = NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'Recording Fee # 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- CALLBuilding Official or his/her Deputy: and Foes are paid, and TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED IN VIOLATI HE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION r pt is acknowledged In space provided. WORKME S TION INSURANCE AND RCW 18:27, FICIAL I ATU _ DA SIGN NER %T1, DATE SIf ED I;4aS) 6S 09 "'le�'� 771-OZ2O R EA D DA ATTENTION I 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- IGwni -Flip •YELLOW -INSPECTOR FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109 / IBC110 7 IRC110. PINK - OWNER • GOLD - ASSESSOR 10104 PRESS HARD - YOU ARE MAKING 4 COPIES it,