20050092.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OVV1jER NAMEINAME OF BUSINESS
MAILING ADDRESS
CITY ZIP TELEPHONE
NAME
NAME CBL#
00"
01
PERMIT EXPIRES
�ERMIT
NUMBER
C -/L
JOB
ADDRESS
SUITElAPT#
[EXISTING
PLAT NAME/SUBDIVISION NO
LOT NO
I
LID NO
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPApp(oved
0
RAI Pe(mit Req�uired
E3
Street use Punt�.t Requiled
PROPOSED
inspection Required
E3
ADDRESS I
1;7:5�,e4 6YO,
CITY ZIP TELEPHONE
�7 1 j .1 :1
STATE LICENSE NUMBER EXPIRATION DATE 13Y
14601<104 C4_]5�9 00 &0 11 rz, 14>4 4 1
PROPERTY TAX ACCOUNT PARC.ELJ�Q
NEW
ADDITION
El REMODEL
REPAIR
Q rOLISH:�
GARAGE
z
CARPORT
(TYPE OF USE, BUSIN
NUMBER
w
OF
01
STORIES
I DESCRIBE WORK TO I
RESIDENTIAL
COMMERCIAL
MIXED USE
MULTIFAMILY
GRADING CYDS
TANK
oRETAINING WALL
ROCKERY
DONE
NUMBER OF
DWELLING
UNITS
1:1 PLUMBING I MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( X
[:] OTHER
FIRE SPRINKLER
FIREALARM
Sidewalk Required 0
underground 13
REQUIRED DEDICATION FT W, uired E3
METER SIZE NO. OF FIXTURES PRV REQUIRED
N013 0
YESO
REMARKS,e��-%t� Lu
z
OWN E R(rT*CT§TRMI1jtFqM ReL1% 0
_KNff &AWStIS —
z
W
ENGINg0MG:RrVJEWZ�lTBY
C20,�UMP AT APPROVED DUMP SrM ONLT
FIRE REVIEWED BY DEMOLInON N� r"
uj
"0 �j
0 CEHEC JOB CARD
n gr_Gr QDj _
VARIANCE OR CU f-SHORELAEf Of -I Abw#- n SEPA
COMPLETED I EXEMPT
DYES 0 Nol
CAN ZONE SIGN AREA HEIGHT
WAIVER 13 ALLOWED PROPOSED ALLOWED , PROPOSED
STUDY 13 1 1
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR
z
4
PARKING I LOTAREA I PLANNING REVIEWED BY DATE CL
REO'D I PROVIDED
FT.) I REMARKS I
CON
SPECIAL INSPECTIO
REQUIRED 13YES
BY:
STRUCTURAL DESIGN
DT�
VALUATION
$
too
Description
Plan Check
HETT FSOURCE
I
�
LOT SLOPEO/6'
VESTED DATE
Building Permit
.
PLAN CHECK NO:
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Grading
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
Engr. Review
SEPARATE PERMISSION.
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr, Inspection
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESSORS
IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
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
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISIOW'
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee __I_
CALL
ORINSPECTI
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THEOWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING TH WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIO.AX WOF TH L DE OF THE STATE OF WASHINGTON RELATING TO
WOS EN' COMPE I SU NCEANDRCW18:27.
OCCUPANT
GROUP
CONSULTANT
OCCUPANT
LOAD
FEE Description
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt N
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or hisihm Deputy: and Fees are paid, and
receipt is acknowledged in space provided
IGNAT iEtll;tw�,AOR DATE SIGNED kill
6
0, 771-0220 RELEASE
110 EXT. 133 el�
ATTENTION
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 if IRC110.
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
4
ORIGINAL - FILE YELLOW - INSPECTOR
PINK -OWNER GOLD - ASSESSOR
z
0
1
0
M
71 _n
M
C
M
0
__10
0 C
rfj
M Z
x
CD
.0 _n
n
M M
a 5)
0 117,
0 M
C 0)
K 0)
Q 0
Z
>
z
z
0
0
M
IMI E� D NTR', Y
OFF LIMITS TO UNAUTHORIZED PERSONNEL
aged and saf
has been da ety
is structure, m
DATE: I O,Xu
is questionable. ,Entry permitted only as
TIME: P
described -below' - and -at. own risk.
h ks or o events may res
Aft thee. ult in
ers oc
death orinjury
t d
This structure wag nsppc e
ons, or,r
under emergencytonditi f
��':RESTRICTIONS ON USE:
the CITY OF EDMONDS on.the.�
r emergency pu rposes on
gntry fo ly
0
date and time, n ted
Other
x�, C'Onl'-C 0,R40,;zk_,
Inspector Initials ID Number,.
Structu'r e- Name and Address:
S b
�n
07 0d,
UTHORIZED BY -AUTHORITY%
DO NOT REMOVE- THIS PLACARD UNTIL A GOVERNING
J