20050138.pdfN
CEIVED
A PERMIT EXPIRES
PERMIT Z� 7
CITY OF EDMONDS NUMBER 4042
CONSTRUCTION PERMIT APPLICATION JOB - -7 SUITEIAPTP
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OWNER NAMEINAME OF BUSINESS 1 -1-4
PLAT NAME/SUBDIVISION NO, LOT NO, LID NO,
MAILINGAIDDRESS I
W LID FEE S
z TESCPApproved 13
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. RW Permit Re uned El
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Street Use Permit Requited 13
CITY ZIP TELEPHONE EXISTING __ PROPOSED Inspection Required [3
Sidewalk Required E3
q REQUIRED DEDICATION FT Undtirg(ound 0
976o 6 63 1 Winno requited 13
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES NO z
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I= ADDRESS REMARKS 111
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE z
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CITY ZIP TELEPHONE
NAME CBL4
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ENGINEERING REVIEWED BY DATE
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FIRE REVIEWED BY DATE ILI
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VARIANCE OR CU SH ORELINE OR ADB# INSPECTION SEPA
STATE LICENSE NUMBER E IRATION DATE 31, CKED By I REQ-0 . coMPLETED EXEMPT
1z1_-r I 13YES 13NO
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6�) H I(E.Sqe? �a 1111 CAP ZONE SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO.
WAIVERM ALLOWED I PROPOSED ALLOWED ROPOSED
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RESIDENTIAL PLUMBING MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
1:1 NEW Of [�K ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
COMMERCIAL COMPLIANCE OR z
1:1 ADDITION 1 2
MIXED USE El CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY DATE 5
1:1 REMODE L El MULTIFAMILY SIGN REO'D I PROVIDED M
REPAIR GRADING FENCE
CYDS x FT.) REMARKS
DEMOLISH TANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
z CARPORT ROCKERY FIREALARM
jE (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
9: TYPE O.FCONSTRUCTION C E I OCCUPANIFJ-7
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GROUP
of tu NUMBER NUMBER OF
UMB 22
OF Ll OCCUPANT
DWELLING SPE6AL!rINSPECTION CONSULTANT
UW
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NITS LOAD
0 STORlk2#- REQUIRED 13YES
DESCRIBE WORK TO BE DONE
REMARKS
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STRUCTURAL DESIG%�i""
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VALUATION
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Description FEE Description FEE
HEAT SOUR E LOTSLOPE% VESTED DATE Plan Check State Surcha I rge _75-77-7-
"f Building Permit City Surcharge
Base Fee
WCHECK 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 Grading
SEPARATE PERMISSION.
2- Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
W
1116 PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) S Fire Review Plan Chk. Deposit
U) 'APPLICANT, ON BEHALF or HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSOR
Uj
_1 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 #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
xi 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 Landscapo Insp Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Fee
Recording Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION AP �ROVAL'
GIVEN IS CORRECT: AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF Thib jilplilication it, nota permil lintil signed by Ihe
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC. CALL fluilding Official or tioutior Dopuly and Footiaro paid and
TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED rucelpt 13 acKilo AtIfidoml In spacni Provided
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
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DAI;SI?NED
SIGNA>pe (OWNER OffIGE (425) n
771-0220 "to 11Y
ATf ENriON EXT. 1333
ITIS UNLAWFUL TO USE OR OCCUPYA BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL � Flif yCIi0W INSM-17101
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC`109 I IBC110 I IRC1110. OINK OWNIF.H (1,0[D ASSr.SSOR
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