20050085.pdfCEIVED
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PE�RMIT EXPIRES
PERMIT 7
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB
ADDRESS�,& SUITE/APTP
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ER NAMEINAME OF BUSINESS jL
kl% r% /If In i PLAT NAMEISUB DIVISION NO. LOT No. LID NO
MAILING ADDRESS
1�6 66 1 ? 7 0
CITY ZIP TELEPHONE
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NAME
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ADDRESS
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STATE LICENSE NUMBER EXPIRATION DATE
��UA_ 7
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PROPERTY TAX ACCOUNT PARCEL NO
NEW
XRESIDENTIAL
ADDITION
COMMERCIAL
MIXED USE
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
Ei
RETAINING WALL
CARPORT
ROCKERY
jTYPE OF USE, BUSINESS PR ACTIVITY) EXPLAIN:
PLUMBING I MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( _X_
El
OTHER
FIRE SPRINKLER
FIREALARM
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
0
0
RW Pormil Required
Street Use Permit Required
13
EXISTING PROPOSED
inspection Required
E3
Sidewalk Required
13
DI
REQUIRED DE 2A
Unritwilrawn
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13
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installed oil 4
U'PC 6011
ENGINEERING REVIEWED BY DATE
FIFF=V1E__ ors requir%* LU
.1y wERY r L vent connect a:
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EXEMPT
CA# ZONE SIGN AREA HEIGHT
WAIVER 13 ALLOWED PROPOSED ALLOWED PROPOSED
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STUDY E3 , I
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
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PARKING
LOTAREA
PLANNING REVIEWED BY DATE
REO'D . PROVIDED
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,
FIT.) I REMARKS
OCCUPANT
GROUP
NUMBER
NUMBER OF
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OF
DWELLING
StE-:C'ILAL21�NSPi�(,TION7CONSULTA.NT
STORIES 2-�
'FE—SCRIBE
UNITS
,S
REQUIRED C3 YES
TOCACDUPANT
Lo
WORK TO BE DONE
REMARKS
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GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
&CID
$
Description
FEE
Description
FEE
Plan Check.
State Surcharge
HEATSOURCE
LOTSLOPE%
VESTED DATE
Building Permit
City Surcharge
PLAN CHECK NO:
Plumbing
Base Fee
7)
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
Grading
DONMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
U)
Fire Review
Plan Chk. Deposit
Uj IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
_j
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
Landscapelnsp.
Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
xi
-
Recording ee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION AP
3ROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
This application is not a pormit 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 Official or his1her Deputy! and Fees are paid, and
IN VIOLATION OF THE LA DE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt is acknowledged in space provided
WORKMEN'S COMPENS N INSU
NCE AND RCW 18:27.
OFFICIALS ISIGNAT RE DtiTE
SI;FE(OWNERO LG�N,):
DATE_/IGNED
(425)
11' /OV_�
771-0220
ELEASED BY DATE/
ATTENTION
EXT. 1333
1�
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. UBC109 / IBC110 / IRC110.
PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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