20051016.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF B SINESS
PERMIT
NUMBER
��
PERMIT EXPIRES
cJOB
oos fo��
ADDRESS J �. � ` , CJ /i /�UITE/APTp
v' V V Y �� ! C. PLAT NAME/SUBDIVISION NO. ' / LOT NO. LID NO
W MAILING ADDRESS `7 LID FEE 5
O eeo�(/ o /,/I L PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved ❑
RW Permit Required - ❑
CITY ZIP 7 .Street Use Permit Requited ❑
C� EXISTING PROPOSED Inspection Required Cl
/� / Sidewalk Requited ❑
J Y. // REQUIRED DEDICATION FT Underground ❑
Wiring required ❑
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
U
YES D NOD z
_ ADDRESS REMARKS s
W
OWNER/CONTRALu
CTOR RESPONSIBLE FOR �1395LQN.CONTROWBRMNAe z
CITY ZIP TELEPHONE In addition to tete required W
ressure/reliefvalvett an approveu
NAME
&ly�' ,&0 b CB j` ��/ listed exParas a�� an
C� ! 7` ENGINE E01 Anks
Dj
� ADDRESS r�,�^� to
11.2
*,4ue
FIRE REVIEWED BY DATE w
CI ZIP TELEPHONE m
G Wiz- % "
STATE LICENSE NUMBER EXPIRATI N TE C BY . VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
/7 f 7 /^, ��� C) REQ'D COMPLETED EXEMPT
(//S// �{-�/C�Jj �/�►L1 l/ G G`/ DYES D NO
PROPERTY TAX ACCOUNT PARCEL NO. CA# ZONE SIGN AREA HEIGHT
W � -? 3 �� /���/) WAIVER D ALLOWED PROPOSED ALLOWED PROPOSED
v v �,; STUDY D
❑ NEW RESIDENTIAL P`UMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT,)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
❑ADDITION ❑ COMMERCIAL COMPLIANCE OR _
❑ MIXED USE ❑ CHANGE OF USE i
❑REMODEL ❑ MULTIFAMILY SIGN PARKING LOTAREA PLANNING REVIEWED BY DATE g
❑ REQ'D PROVIDED a
❑ REPAIR ❑ GRADING ❑ FENCE
CYDS ( X FT.) REMARKS
❑ DEMOLISH ❑ TANK ❑ OTHER
z ❑GARAGE RETAINING FIRE
CARPORT ❑ ROCKERY WALL ❑ FIREA ARM SPRINKLER
O
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: /7
TYP COON$T CTI COD OCCUPAN
f U GROUP
GNUMBER NUMBER OF V
a OF DWELLING SPEt.IAL INSPECTION CONSULTANT OCCUPANT
O STORIES UNITS REQUIRED DYES
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
O
/Q-{� z
GEOTECH REPORT 5
BY: m
STRUCTURAL DESIGN
BY:
O CL Lldld2icl VALUATION
Aeoz eo/ 471 /lzi /1r $
Uhf,! Ute Description FEE Description FEE
Xi Q T1 " Plan Check Slate Surcharge
HEAT SOU LOT SLOP /a V STED ATE
�...J I Building Permit City Surcharge
P N CHECK NO:
Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO Mechanical
I=
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC Gradin
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g
SEPARATE PERMISSION,
Engr. Review
W PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
d 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
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Recei t #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY p
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 Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT 1 AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE L ODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENS NS NCE AND RCW 16:27,
OF I IGNA E DATE
SIGNAT E(OWNER AG NT): /� D� SIGHED (425) A(
771 =0220 RELE U DATE
T NTIONEXT. 1333
CCU�i
IT IS UNLAWFUL TO USE OR PY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 I PINK IRC110, ORIGINAL -OWNER YELLOW -INSPECTOR •GOLD -ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
O
M
vM
C
0
n
OC
_ M I
mZ
IC) ==I
a z
r_ -I
mm
O�
0 m
M Cl)
r m 0
2
z ,.
O
n
M