20050137 (2).pdfDATE RECEIVED / G
G ��%J PERMIT EXPIRES �)
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION ooREss n SUITE!APT#
E �s2cx� Jb6 f
OW ER NAMEINAMj OF BUSINESS t /
/ : , `71 /7 r , �r PLAT NAME!SUBDIVISION NO. LOT NO LID NO.
ce M (LING ADDRESS CC �� 1 LID FEE $
Z P�;O �) "� �� { PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved ❑
RW Permit Rxnwt R E3CITY
ZIP TELEPHONE EXISTING PROPOSED Street use Permit uQcued 13
Sidewalk Required
2 . �� Cr _S— REQUIRED DEDICATION _ FT O
UnWm Wiring
required E3rwtetl ❑
NAME METER SIZE LINE S17 NO. OF FIXTURES PRV REQUIRED
F
u YES O NO CI z
W
t ADDRESS REMARKS i
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
Q z
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CITY ZIP TELEPHONE
NAME %� CBL#
` ` v ENGINEERING REVIEWED BY DATE
x ADDRESS
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im-FIRE REVIEWED BY DATE w
O SCLT YTELEPHONES
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STATE LICENSE NUMBER EXPIBATION DATEC VARIANCE OR Cu SHORELINE OR ADB# INSPECTION SEPA
ceREQ'D COMPLETED EXEMPT7`/ 0 YES 0 NO
4 PROPERTY TAX ACCOUNT PARCEL NO, CA# ZONE SIGN AREA HEIGHT
W t�WAIVER .13 _ ALLOWED PROPOSED ALLOWED PROPOSED
STUDY O
❑ NEW RESIDENTIAL PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
❑ COMMERCIAL COMPLIANCE OR z
❑ ADDITION ❑
❑ MIXED USE CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY DATE g
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REO'D PROVIDED a
❑ REPAIR ❑ GRADING CYDS ❑ FENCE
( X FT.) REMARKS
❑ DEMOLISH ❑ TANK ❑ OTHER
GARAGE RETAININz ❑ FIRE S
CARPORT ❑ ROCKE YG WALL ❑ FIREALARM RINKLER
a. (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
re TYPEO ONSTRU TIO COODE f� OCCUPANT
5./.J GROUP
o NUMBER NUMBER OF
m OF r- DWELLING I SPECIAL INSPECTION CONSULTANT OCCUPANT
O STOA1 UNITS LOAD
DE9MBE WORK TO BE DONE REQUIRED DYES
REMARKS 0
�+ 7 C GEOTECH REPORT
STRUCTURAL DEI or L Vent connectors required
BY:
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714
Description FEE Description FEE
/)//7 �� Plan Check State Surcharge
AT SOURCE LOT SLOPE% VESTED DATE /
CL Building Permit City Surcharge .
PIL . Ali CHECK NO:
Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical _l
It: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
Lu PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
a PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engf. Inspection.
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
y *APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
at IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
z
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
C 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 Landscape Insp. Total Amt. Due
= NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee 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
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 16:27. OFFjGI LS SIGNAT _ <. DATE
SIGNA RE (OWNER O DATES NED x425) �' l
L} ` l' , l0
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/ v�Y 771 -0220 R EA� Y v AT
ATTENTION EXT. 1333,�._-------__..-----._.__._-._------------- --_.
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL IN51'tG I IUN MAS bt:t:N MAUt ANU AVI'KUVAL UK A GtK 111
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110. ORIGINAL - FILE YELLOW -INSPECTOR
PINK -OWNER •GOLD -ASSESSOR
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