20050131.pdfDATE RECEIVED
PERMIT EXPIRES 2
PERMIT
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITEIAPT#
OWNER NAMEINA ADDRESS
ME OF BUSIUf SS /C
PLAT NAME/SUBDIVISION NO. LOT NO. L�11) NO
MAILING ADDRESS
W LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP I ESCP Approved L3
30. S 16 3 RW Permit Required C]
TELEPHONE EXISTING Street Use Permit Required 0
CITY-% ZIP PROPOSED InspeCtion Required CI
Sidewalk Required E3
REQUIRED DEDICATION FT Underground E3
SA&4td_S Y-LT7 71y— 3 - 2. Wifinci required
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
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STATE LICENSE NUMBER EXPIRA ION AT VARIANCE OR CU SHORELINE ORADBI INSPECT'o SEPA
REO'D COMPLETED I EXEMPT
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NEW RESIDENTIAL PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
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ADDITION 1 2
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PARKING LOT AREA PLANNING REVIEWED BY DATE
REMODEL MULTIFAMILY SIGN REQ*D PROVIDED
GRADING FENCE
REPAIR CYDS X FT.) ARKS
DEMOLISH TANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
z CARPORT ROCKERY FIREALARM
(TYPE OF USE, BUSIV4S OR ACTIVITY) EXPLAIN:
TYPE DE CONSTRWCTION Col;tq�%, OCCUPAN
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uu NUMBER NUMBER &
OF DWELLING SPtCIAL INSPECTION CONSULTANT OCCUPANT
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DESCRIBE WORK TO BE DONE
REMARKS
I;r re GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY: A F F I iFlf it, ii�
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Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE LOTSLOPE% VESTED DATE Building Permit City I Surcharge
PLAN CHECK NO: Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
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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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
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_j IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
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< ALL CLAiMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
In DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
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0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Be Receipt #
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 his/her Deputy: and Foos are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED receipt is acknowledged in space provided.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION 11
,WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27. 0 ' I IALS SIGN U DATEr
E (OWNER 0 G DA SIPNED (4:25) 4
24a, 6
771-0220 ELE BY cl)A�E
TION EXT. 1333 -------
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 1 —1
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A GERTI- ORIGINAL - FILE YELLOW - INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 I IBC110 i IRC110. PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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