20050153.pdfDATE RECEIVE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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ADDRESS
12334 I?6
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NAME
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ZIP I TELEPHONE
r_ PERMIT EXPIRES
PERMIT _
NUMBERl—
JOB _ / SU F/ PTG
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PLAT NAME/SUBDIVISION NO. LOT NO, LID NO.
LID FEE S /
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApproved 0
RW Permit Required 0
Street EXISTING _ PROPOSED inspection Requited
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Srdowalh Required LJ
REQUIRED DEDICATION of' FT Underground 0
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Wiring Inquired 17
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES 0 NO O z
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REMARKS Z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE u
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FIRE REVIEWED BY DATE
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NISE NUMBER EXPIRATION DATE CHECKED BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA 4
COMPLETED EXEMPT 0
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CA# le t✓Mr ZONE SIGN AREA I$1 HE
TAX ACCOUNT PARCEL NO. — 11
1 1 �. �'� D 3 WAIVER 0 ALLOWED PROPOSED ALLOWED PROPOSED
STUDY O
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RESIDENTIAL LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
❑ NEW ❑ ❑ PLUMBING/ MECH 0 rn
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR
COMMERCIAL COMPLIANCE OR N^ iNQ ? rn O
❑ ADDITION ❑ MIXED USE ❑ CHANGE OF USE i •� 0
❑
REMODEL PARKING LOTAREA PLANNING REVIEWED BY DATE g O C ❑ MULTIFAMILY. SIGN C7j) REO'D PROVIDED
GRADING FENCE N m
❑ REPAIR ❑ CYOS ❑ I m Z
( X FT.) REMARKS
❑ DEMOLISH ❑ TANK ❑ OTHER Prrsr ,/ rr j D Z
GARAGE RETAINING WALLFIRE SPRINKLER' I e '� ' /k✓Ik� r=
Z ❑ CARPORT 13 ROCKERY ❑ FIREALARM
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a(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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NUMBER NUMBER OF
OF / DWELLING !� SPECIAL INSPECTION. CONSULTANT OCCUPANT =
Q STORIES UNITS LOAD m rn
REQUIRED O YES
DESCRIBE WORK TO BE DON0 Ui
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GEOTECH REPORT �
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'7 STRUCTURAL DESIGN
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V�IlaVALUATION ;a
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Description FEE Description FEE 2
r l�r� Plan Check Slate Surcharge
HEAT URCE LOT SLOPE% VESTED DATE _ 0
Building Permit U City Surcharge r O�
PLAN HEC /O;o� ---- Plumbing Base Fee �: 0
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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, RBVIBW
Lu PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
o PERMIT LIMIT: SEE ECDC 19,00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
in In •APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
W 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
= 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 s/ not a permit until signed p the
TION; AND IN DO THE K AUTHORIZED THE BY, NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATI N F HE,LAB C DE OF THE E OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
L / WORKME OMP N�4•AT IN S NCE D C 16:27.
SIGN DAT FIC'S SIGNATU DATE AG T SIGNED (425)
Ail 21 0 771 0220 RE D BY I DATE
ATTENTION EXT. 1333 % �f jll�i,� 1/-/.
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIINSPE-
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC1091 IBC1101IRC110..✓ y/ �� ' ORIGINAL -FILE •YELLOW ASSESS OR
,, )�ifL // PINK -OWNER •GOLD - ASSESSOR
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