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20051024 (2).pdfDATE RECEIVED CITY OF EDMONDS kMAILING STRUCTION PERMIT APPLICATION /NAME OF BUSINESS G ESS ZIP TELEPHONE I ADDRESS CITY STAT TAXACCOUNT rU PERMIT EXPIRESPERMIT NUMBER C; �cX JOB 9UITEIAPT# ADDRESS PLAT NAMEISUBDIVISION NO. LOT NO. LID NO. LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApproved O RW Permit Required Street EXISTING PROPOSED Inspection Required CI O / Sidewalk Required I] REQUIRED DEDICATION FT Underground 11 Winn qrequired IJ METER SIZE [,,.,0NE SIZE' NO. OF,FIXTURES; ] : P.RV REQUIRED r .. 1'-• ti 1,•4.,x' h. t.`.y.S � REMARKS r r 33 z OWNERICONTRACTOR RESPOq$IBLE FORE §Si N ROLjdAAII$AGE E5 w CBL# �'��'. rF'�%: ne %6e 11 0 F, « equimd. { . . L r%% ENGINEERING�REf%I&W�'DBY" % Y:, r 1 7ir4tRe137:1.3 $l'fS:d� �'dxdl"13 Y��t Y �11Ft;4.d tat+�C� 51'tJt Ccs. 11VIC 803a2 1�-► Ltl FIRE REVIEiWED BY DATE ZIP TELEPHONE it 47 -a 2-�?751_61f67tf LL EXPIRATION DATE C ED BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA REQ'D COMPLETED . E%Ek'PT ^�77 I3 YES 13 NO -v,4 cm—CA# ZONE SIGN AREA HEIGHT �ARCEL NO. WAIVER OALLOWED' PROPOSED ALLOWED PROPOSED (rot STUDY [3 RESIDENTIAL PLUMBING I MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) ^^^------aaa ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR ❑ COMMERCIAL COMPLIANCE OR z ❑ MIXED USE ❑ CHANGE OF USE PARKING IL LOT AREA PLANNING REVIEWED BY DATE g ❑ MULTIFAMILY ❑ SIGN REQ'D PROVIDED ❑ GRADING ❑ FENCE CYDS ( X FT.) REMARKS ❑ TANK ❑ OTHER [:3RETAINING WALL . FIRE SPRINKLER ROCKERY ❑ FIREALARM )R CTIVITY) EXP LA N: n TYPE CO TR►1 I N C OCCUP a, U GROU U GNUMBER NUMBER OF OF DWELLING SPECIAL I SPECTIONCONSULTANT OCCUPANT p .STORIES UNITS - LOAD REQUIRED O YES DESCR E WORK TO BE DONE �- , / �- , / J' /� rl�'i LL �,c2 J►NIVAl N �%%C��rr� AWD. REMARKS Z 6AS •I W D&Z. / ��5 k4f GEOTECH REPORT 5 BY: to 5 > -r to Jew s , STRUCTURAL DESIGN BY: aE�FC�C.. � of - N QTS VALUATION LotaA�i�D . LN Red L- P.,4Of,", rNS1DE $ HRO V6P G1.7— 44 5 IEC�P)466 Description FEE Description FEE Plan Check State Surcharge HEAT SOURCE LOT SLOPE% VESTED DATE N Building Permit 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 Grading DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g I= SEPARATE PERMISSION, Engr. Review Iz w PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5) IL PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection SEE BACK OF PINK PERMIT FOR MORE INFORMATION •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 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 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 pormd until signed by the THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building receipt i nr acknowledged Deputy ut and Foos are paid, and IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION rocaPt rs acknowledgod dr space provided WORKMEN'S COMPENSATION NSURANCE AND RCW 10:27. FF S SIC A URE DATE SIGNAT (OWNER OR GEN DATE SIGNED �y (425' t� �Ct �� ' 771'•0220 R EASL lY 1 DATE ATTEN ION 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 IBC1101 IRC110• PINK -OWNER GOLD - ASSESSOR 10104 PRESS HARD - YOU ARE MAKING 4 COPIES Z + 0 m eM, M 0 OC -'I =m M Z Q � DZ r_ -•1 MM O en r M KCn I Mn Z� . 2 z Cn2 Z O 0 rn ❑ NEW ❑ ADDITION ❑ REMODEL ❑ REPAIR ❑ DEMOLISH ❑GARAGE Z CARPORT (TYPE OF USE, Bt rU PERMIT EXPIRESPERMIT NUMBER C; �cX JOB 9UITEIAPT# ADDRESS PLAT NAMEISUBDIVISION NO. LOT NO. LID NO. LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApproved O RW Permit Required Street EXISTING PROPOSED Inspection Required CI O / Sidewalk Required I] REQUIRED DEDICATION FT Underground 11 Winn qrequired IJ METER SIZE [,,.,0NE SIZE' NO. OF,FIXTURES; ] : P.RV REQUIRED r .. 1'-• ti 1,•4.,x' h. t.`.y.S � REMARKS r r 33 z OWNERICONTRACTOR RESPOq$IBLE FORE §Si N ROLjdAAII$AGE E5 w CBL# �'��'. rF'�%: ne %6e 11 0 F, « equimd. { . . L r%% ENGINEERING�REf%I&W�'DBY" % Y:, r 1 7ir4tRe137:1.3 $l'fS:d� �'dxdl"13 Y��t Y �11Ft;4.d tat+�C� 51'tJt Ccs. 11VIC 803a2 1�-► Ltl FIRE REVIEiWED BY DATE ZIP TELEPHONE it 47 -a 2-�?751_61f67tf LL EXPIRATION DATE C ED BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA REQ'D COMPLETED . E%Ek'PT ^�77 I3 YES 13 NO -v,4 cm—CA# ZONE SIGN AREA HEIGHT �ARCEL NO. WAIVER OALLOWED' PROPOSED ALLOWED PROPOSED (rot STUDY [3 RESIDENTIAL PLUMBING I MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) ^^^------aaa ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR ❑ COMMERCIAL COMPLIANCE OR z ❑ MIXED USE ❑ CHANGE OF USE PARKING IL LOT AREA PLANNING REVIEWED BY DATE g ❑ MULTIFAMILY ❑ SIGN REQ'D PROVIDED ❑ GRADING ❑ FENCE CYDS ( X FT.) REMARKS ❑ TANK ❑ OTHER [:3RETAINING WALL . FIRE SPRINKLER ROCKERY ❑ FIREALARM )R CTIVITY) EXP LA N: n TYPE CO TR►1 I N C OCCUP a, U GROU U GNUMBER NUMBER OF OF DWELLING SPECIAL I SPECTIONCONSULTANT OCCUPANT p .STORIES UNITS - LOAD REQUIRED O YES DESCR E WORK TO BE DONE �- , / �- , / J' /� rl�'i LL �,c2 J►NIVAl N �%%C��rr� AWD. REMARKS Z 6AS •I W D&Z. / ��5 k4f GEOTECH REPORT 5 BY: to 5 > -r to Jew s , STRUCTURAL DESIGN BY: aE�FC�C.. � of - N QTS VALUATION LotaA�i�D . LN Red L- P.,4Of,", rNS1DE $ HRO V6P G1.7— 44 5 IEC�P)466 Description FEE Description FEE Plan Check State Surcharge HEAT SOURCE LOT SLOPE% VESTED DATE N Building Permit 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 Grading DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g I= SEPARATE PERMISSION, Engr. Review Iz w PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5) IL PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection SEE BACK OF PINK PERMIT FOR MORE INFORMATION •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 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 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 pormd until signed by the THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building receipt i nr acknowledged Deputy ut and Foos are paid, and IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION rocaPt rs acknowledgod dr space provided WORKMEN'S COMPENSATION NSURANCE AND RCW 10:27. FF S SIC A URE DATE SIGNAT (OWNER OR GEN DATE SIGNED �y (425' t� �Ct �� ' 771'•0220 R EASL lY 1 DATE ATTEN ION 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 IBC1101 IRC110• PINK -OWNER GOLD - ASSESSOR 10104 PRESS HARD - YOU ARE MAKING 4 COPIES Z + 0 m eM, M 0 OC -'I =m M Z Q � DZ r_ -•1 MM O en r M KCn I Mn Z� . 2 z Cn2 Z O 0 rn