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20051153A.pdf— I DATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMErNAME OF BUSINESS MAILING ADDRESS CITY ZIP TELEPHONE NAME ADDRESS CITY ZIPTELEPHONE j-iY I�;n i Irdh .� r NAME CBL# PERMIT EXPIRES L� PERMIT L-- --^ NUMBER JOB h SJULT APT# ADDRESS 71 LO PAT NAME/SU©DIVISION NO, LOT NO. LID NO, LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApproyed ❑ RW Permit Required ❑ Sheet Use Permit Required ❑ EXISTING PROPOSED Inspection Required ❑ Sidewalk Required ❑ REQUIRED DEDICATION FT Underground ❑ '— •— Wifinq required ❑ METER SIZE LINE SIZE NO. OF FIXTURESPRV REQUIRED YES O NO O z z W w REMARKS w OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE z L7 it ENGINEERING REVIEWED BY DATE K ADDRESS - t FIRE REVIEWED BY DATE LU CITY �" ZIP TELEPHONE no7Ni� �v'fJ �! �;: Z zz STATE LICENSE NUMBER EXPIRATIO DATEI(OBY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA L✓�'t REO'D COMPLETED EXEMPT `✓ I `4� * V a DYES NO CA# ZONE SIGN AREA HEIGHT a PROPERTY TAX ACCOUNT PARCEL NO. _ WAIVER 0 ALLOWED PROPOSED ALLOWED PROPOSED J UU `! %' / CJc) C� (,JC..: <-Gr(� STUDY O ❑ NEW RESIDENTIAL❑ PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) ALLOWED PROPOSED FRONT SIDE REAR. FRONT URSIDE REAR O ❑ ADDITION 1:1COMMERCIAL ❑ COMPLIANCE OR z 1:1MIXED USE CHANGE OF USE z PARKING LOTAREA PLANNING REVIEWED BY DATE REMODEL g 1:1 MULTIFAMILY ❑ SIGN REQ' PROVIDED LM 1:1 GRADING CYDS ❑ FENCE X FT.) REMARKS REPAIR ❑ DEMOLISH ❑ TANK ❑ OTHER. z ❑GARAGE FIRE CARPORT ❑ ROCKE YG WALL ❑ FIRER ARM SPRINKLER It (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: Gam, TYPE OFC NSTRUCTION CQD OCCUPANT v ,J GROUP wNUMBER NUMBER OF OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT 100 O STORIES UNITS LOAD REQUIRED C] YES DESCRIBE WORK TO BE DONE j/1n / 1 v/ {, REMARKS Z GEOTECH REPORT � •� + BY: t4^ m �vt1�r4�1)tM-S l%{' 11i'q4itr peii STRUC }ESIGN j BY: �"l[ .T_J'A%MIt�.1% E r'!' C ! Op 1 G? ��►' VALUATION $ 6111 M 93� Description FEE Description FEE Plan Check Slate Surcharge S H iaAT SOURCE. LOT SLOPE% VESTED DATE Building Permit l-Base y Surcharge PLAN CHECK NO: 0 _ r Plumbing' Feeoe THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO Mechanical Cl) BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBIC Grading DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g t SEPARATE PERMISSION, Engf. Review w PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5) IL PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) SEE BACK OF PINK PERMIT FOR MORE INFORMATION Eflgf. Inspection *APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit UJI IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF M�� 2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt # ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY r!1/"' FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE/1, �/? DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due003ate• _ NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.• Recording Fee Receipt # I HEREBY ACKNOWLEDGE THAT 1 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 his/her Deputy: and Fees aro 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 receipt is acknowledged in space provided WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27, C OFFICIALS SIGNATURE DATE SIG (OWNER O GENT): DATE SIGNED (425) �'v 771 -0220 RELEA Y DATE ATTENTION EXT. 1333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL OLr A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL FILE YELL -INSPECTOR FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109 / IBC110 / IRC110. PINK -OWNER GOLD - ASSESSOR 110104 PRESS HARD - YOU ARE MAKING 4 COPIES O m � T ui =. c m my 0C C =m M 10 MA DZ O mn mm O� r C �' ( Zr pZ1 Z mmit Z 0 m