20050027.pdfCEIVED PERMIT EXPIRES
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PERMIT
CITY OF EDMONDS NUMBER
JOB SUITEIAPTN
CONSTRUCTION PERMIT APPLICATION ADDRESS
OWNER NAME/NAME OF 13US114ESS
J) 1) 1\ f/ PLAT N AMEiSUBDIViSION NO. LOT NO. LID NO.
MAILING ADDRESS LID FEE S
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3: PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Appfmea C3
0 Ax/L RW Permit Required C3
Street use Permit Required 13
C)TY 71P TELEPHONE EXISTING PROPOSED Inspection Required 13
1 j— i ) �3020 REQUIRED DEDICATION Sidewalk Required CI
Ed) FT Unciftrground 13
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NAME METER SIZE LINE SIZE NO. OF F IXTURES PRV REQUIRED
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OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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STATE LICENSE NUMBER EXPIRATION DATE Y REO'D 01 COMPLETED I EXEMPT
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RESIDENTIAL LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
NEW LUMBING / MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR
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ADDITION COMMERCIAL COMPLIANCE OR 2
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PARKING LOT AREA PLANNING REVIEWED BY DATE
ED REMODEL MULTIFAMILY 11 SI GN REO'D PROVIDED
GRADING FENCE I
REPAIR CYDS 0 x FT.) REMARKS
DEMOLISH TANK 13 OTHER
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(TYPE OF USE, BUSINEaZ OR ACTIVITY) EXPLAIN:
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OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
UNIT LOAD
0 STORIES REQUIRED DYES
DESCRIBE WORK TO BE DONE
REMARKS
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STRUCTURAL DESIGN
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VALUATION
Description FEE Description FEE
Plan Check State Surcharge
_[_____�ESTED DATE Building Permit Q city Surcharge
HEAT SOURCE LOTSLOPE%
PLAN CHECK NO: Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION. Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
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06 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 ipt #
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND Fire Inspection Rece
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 Landscapelnsp. Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
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I Receipt #
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- CALL Building Official or his1hor Deputy: and Fees are 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 c��SATION INSURANCE AND RCW 18:27. OFRrIALSSIG TURE /ATE
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771-0220 EDBY
ION EXT. 1333
IT Iq t]Nt AWFt]L 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. UBC109 / IBC110 / IRC110- PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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