20050136.pdfDATE RECEIVE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILINGADDRESS
-76, jf 61 J/4 fl- J
CITY ZIP TELEPHONE
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NAME
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ADDRESS
PERMIT EXPIRES 3 "V
PERMIT 1
NUMBER
JOB UITEIAPT#
ADDRESS -7�
PLAT NAMEISUBDIVISION No,
LOT NO.
LID NO
I
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
El
0
RW Pemit Required
Street Use Permit Required
13
EXISTING PROPOSED
Inspection Required
13
Sidowalk Requited
13
REQUIRED DEDICATION FT
Underground
0
0
Winne foquifed
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV RE QUIRED
YES13 NOM
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REMARKS
W
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OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
5
/ I I on fuel -burning appliances passing
-4 ENGINEE11thi'ViffffiPhynheated spaces. IMEA903.2
ZIP TE EPHONE
_2ZP-2�
_0ATE LICENSE NUMBER EXP RATION ATE
11�12 �' I
PROPERTY TAX ACCOUNT PARCEL NO.
NEW
RESIDENTIAL
ADDITION
COMMERCIAL
MIXED USE
13
REMODEL
MULT IFAMILY
13
REPAIR
GRADING CYDS
1:1
DEMOLISH
TANK
GARAGE
Ei
RETAINING WALL
CARPORT
ROCKERY
wr
FIRE REVIEWED BY DATE W
VARIANCE OR CU SHORELINE ORADB# i INSPECTION SEPA
REQ'D COMPLETED I EXEMPT
DYES [3NO1
CA# ZONE SIGN AREA HEIGHT
WAIVER [3 ALLOWED I P ROPOSED ALLOWED PROPOSED
STUDY 13 1 1 1
LOT COVERAGE
REQUIRED SETBACKS (FT.),
PROPOSED SETBACKS (FT.)
PLUMBING / MECH
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT L/RSIDE REAR
COMPLIANCE OR
z
CHANGE OF USE
PARKING
LOT
REVIEWED BY DATE
I
L_j SIGN REQ D PROVIDED
FENCE
( X FT.) REMARKS
OTHER
FIRE SPRINKLER
FIREALARM r
111111111194
ILL
a
C')
NUMBER
SOFORIES (�'_
NUM ER OF
DWEBLLING
UNITS
SPECIAL INSPECTION
REQUIRED
CONSULTANT
DESCRIBE WORK TO BE DONE
REMARKS
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
1tv"), t.2
VALUATION
$
Description
FEE
Plan Check
HE&T SOURCE
LOT SLOPE%
VESTED DATE
Building Permit
PLA1411CHECK NO:
Plumbing
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
SEPARATE PERMISSION.
Grading
Engr. Review
Lu
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
OCCUPANT
GROUP
OCCUPANT
LOAD
Description
State Surcharge
City Surcharge
Base Fee
FEE
to
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*APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
Fire Review
Plan Chk. Deposit
A
J IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
E EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Landscapelnsp.
Total Amt. Due
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
ziNOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION..
-
Recording Fee
I
Receipt # -1/2
`
—
APPLICATION APPROVAL
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
This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
CALL
Building Official or titsther Deputy: and Fees are paid, and
TION; AND
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
/`fe�eipt is acknowledged in space provided.
/ ; I q 11
OFFI SI N / URE DATE
WORKMEN'S co!:=URANCE AND RCW 18:27.
(425)
�E (OWNER f RA-EPTY)
DATE TGNEP
I 'n 'F
A 771 w0220 RELEASED
I
TION EXT. 1333
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.
110104 PRESS HARD - YOU ARE MAKING.4 COPIES
ORIGINAL -FILE YELLOW -INSPECTOR
PINK -OWNER GOLD - ASSESSOR
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