20051157.pdf5aAe���� ORROR
DATE CEIVE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
Ago
ZIP I TELEPHONE
TELEPHONE
PERMIT EXrIRES %
PERMIT
NUMBERJOB
ADDRESS / ( r7 /
_ SUITE/APTr �2]
� �C. t
PLAT NAMEISUBDIVISION NO, LOT NO, LID NO.
LID FEE 5
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TLS CP Approved ❑
RW Permit Required ❑
EXISTING _ __._._.Street Use Permit Required E3_. ---_PROPOSED------._..... -.__---. ---._ Inspection Required ❑
SoCA&K Required ❑
REQUIRED DEDICATION FT Underground ❑
—•— "— Wmn re ,e11 ❑
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES C3 NO O
REMARKS 0
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE z
tx
w
W
z
z
z
W
UCL+y ENGINEERING REVIEWED BYDATE -
M AdbRESS RECYCLE REVIEWED BY DATE
M
CITY ZIP TELEPHONE PUBLIC WORKS REVIEWED BY
p . - - DATE n
" i3 _ m
STATE LICENSE NUMBER EXPIRATION DATE C CK BY FIRE REVIEWED BY DATE
w
OO
a PROP TY TAXA COUNT PARCEL NO. VARIANCE OR CU SHORELINE OR ADBa INSPECTION SEPA v m
/� /�j �% REQ'D COMPLETED EXEMPT
W �y' �V !/ _ i� YES i� NO jCTt
❑ NEW ❑ RESIDENTIALCA# ZONE SIGN AREA HEIGHT MORE!0
PLUMBIN / MECH I3 WAIVER ALLOWED PROPOSED ALLOWED PROPOSED O C
�DDITION L1 OMMERCIAL COMPLIANCE R 13 STUDY _
❑ MIXED USE ❑ CHANGE OF USE LOT COVERAGE REOUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) til Z
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR p �
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN _
t7
❑ FENCE
REPAIR C Z
❑ E]GRADING CYDS z r "i
( X FT.) PARKING LOTAREA PLANNING REVIEWED BY DATE 3
❑ DEMOLISH ❑ TANK 1:1 OTHER REO'D I PROVIDED a
zz ❑GARAGE RETAINING WALL FIRE SPRINKLER REMARKS O �J
CARPORT ❑ ROCKERY ❑ FIREALARM D
P (TYPE OF,USE, BUSINESS OR ACT VI_TY EXPLAIN:
M
c NUMBER NUMr
BER OF O
m OF .DWELLING n
o STORIES UNITS 3 TYPE OF CONSTRUCTION CQD� OCCUPANT C
(�jj GROUP I.
DESCRIBE WORK TO BE DONE f OCCUZ �
SPECIAL
REOUIREDINSPECTION
CN
DYES
C� OADPANT r
IF REMARKS X
e-t.i Q 0 /a .0 z ORION!
GEOTECH REPORT
STRUCTURAL DESIGN 1 -I
BY CA
VALUATION
i
$ Z
o
Description FEE Description FEE
0
HEAT SOURCE LOT SLOPE4b VESTED DATE Plan Check State Surcharge m
PLAN CHECK Nb: Building Permit City Surcharge
Plumbing Base Fee so
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC MBChanlcal Rao
9 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
� SEPARATE PERMISSION. Grading
Lu PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5) Engr. RBVIBW
a PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) g . Recording Fee
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection Plan Chk. Deposit
y
"APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
� IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF Fire Review Receipt #
¢ EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Q ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY ..—
= FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE Fire Inspection Total Amt. Due
0 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
_ NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.* Landscape Insp. Receipt a OR
zw-
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 CALL This application is not a ponnit until signed by the
THE OWNER: 1 AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• Budden Official or hlsrher Deputy TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED FOR INSPECTION g P y' and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO receipt Is acknowledged In space provided
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27. (425` OFFICIALS SIGNATURE DATE
OR
SIG URE(OWNER DATE SIG ED GJ1 / 'i .-%/ __,/') 5
'" 771-0220 (- V [/J
7 � t
C� /G- �I J �i�0 R Irl , DATE
ATT NTION EXT. 1333 00 -OR
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109 / IBC110 / IRC110, ORIGINAL • FILE • YELLOW • INSPECTOR
PINK .OWNER a GOLD ASSESSOR
6105 PRESS HARD - YOU ARE MAKING 4 COPIES
CITY
NAME
OR
W
I-
ADDRESS
Ago
ZIP I TELEPHONE
TELEPHONE
PERMIT EXrIRES %
PERMIT
NUMBERJOB
ADDRESS / ( r7 /
_ SUITE/APTr �2]
� �C. t
PLAT NAMEISUBDIVISION NO, LOT NO, LID NO.
LID FEE 5
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TLS CP Approved ❑
RW Permit Required ❑
EXISTING _ __._._.Street Use Permit Required E3_. ---_PROPOSED------._..... -.__---. ---._ Inspection Required ❑
SoCA&K Required ❑
REQUIRED DEDICATION FT Underground ❑
—•— "— Wmn re ,e11 ❑
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES C3 NO O
REMARKS 0
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE z
tx
w
W
z
z
z
W
UCL+y ENGINEERING REVIEWED BYDATE -
M AdbRESS RECYCLE REVIEWED BY DATE
M
CITY ZIP TELEPHONE PUBLIC WORKS REVIEWED BY
p . - - DATE n
" i3 _ m
STATE LICENSE NUMBER EXPIRATION DATE C CK BY FIRE REVIEWED BY DATE
w
OO
a PROP TY TAXA COUNT PARCEL NO. VARIANCE OR CU SHORELINE OR ADBa INSPECTION SEPA v m
/� /�j �% REQ'D COMPLETED EXEMPT
W �y' �V !/ _ i� YES i� NO jCTt
❑ NEW ❑ RESIDENTIALCA# ZONE SIGN AREA HEIGHT MORE!0
PLUMBIN / MECH I3 WAIVER ALLOWED PROPOSED ALLOWED PROPOSED O C
�DDITION L1 OMMERCIAL COMPLIANCE R 13 STUDY _
❑ MIXED USE ❑ CHANGE OF USE LOT COVERAGE REOUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) til Z
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR p �
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN _
t7
❑ FENCE
REPAIR C Z
❑ E]GRADING CYDS z r "i
( X FT.) PARKING LOTAREA PLANNING REVIEWED BY DATE 3
❑ DEMOLISH ❑ TANK 1:1 OTHER REO'D I PROVIDED a
zz ❑GARAGE RETAINING WALL FIRE SPRINKLER REMARKS O �J
CARPORT ❑ ROCKERY ❑ FIREALARM D
P (TYPE OF,USE, BUSINESS OR ACT VI_TY EXPLAIN:
M
c NUMBER NUMr
BER OF O
m OF .DWELLING n
o STORIES UNITS 3 TYPE OF CONSTRUCTION CQD� OCCUPANT C
(�jj GROUP I.
DESCRIBE WORK TO BE DONE f OCCUZ �
SPECIAL
REOUIREDINSPECTION
CN
DYES
C� OADPANT r
IF REMARKS X
e-t.i Q 0 /a .0 z ORION!
GEOTECH REPORT
STRUCTURAL DESIGN 1 -I
BY CA
VALUATION
i
$ Z
o
Description FEE Description FEE
0
HEAT SOURCE LOT SLOPE4b VESTED DATE Plan Check State Surcharge m
PLAN CHECK Nb: Building Permit City Surcharge
Plumbing Base Fee so
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC MBChanlcal Rao
9 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
� SEPARATE PERMISSION. Grading
Lu PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5) Engr. RBVIBW
a PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) g . Recording Fee
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection Plan Chk. Deposit
y
"APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
� IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF Fire Review Receipt #
¢ EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Q ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY ..—
= FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE Fire Inspection Total Amt. Due
0 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
_ NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.* Landscape Insp. Receipt a OR
zw-
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 CALL This application is not a ponnit until signed by the
THE OWNER: 1 AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• Budden Official or hlsrher Deputy TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED FOR INSPECTION g P y' and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO receipt Is acknowledged In space provided
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27. (425` OFFICIALS SIGNATURE DATE
OR
SIG URE(OWNER DATE SIG ED GJ1 / 'i .-%/ __,/') 5
'" 771-0220 (- V [/J
7 � t
C� /G- �I J �i�0 R Irl , DATE
ATT NTION EXT. 1333 00 -OR
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109 / IBC110 / IRC110, ORIGINAL • FILE • YELLOW • INSPECTOR
PINK .OWNER a GOLD ASSESSOR
6105 PRESS HARD - YOU ARE MAKING 4 COPIES