20050167.pdfDATE RECEIVED4
PERMIT EXPIRES
-PERMIT
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APTr!$
ADDRESS
OWNER NAME/NAME OF BUSINESS z/G
PLAT NAMEiSUBDIVISION NO. LOT NO. LID NO�
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MAILING ADDRESS LID FEE S
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z PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApproved
0 A v c, RW Permit Required E3
2�4 Street use Permit Requited 13
CITY ZIP TELEPHONE EXISTING PROPOSED Inspection Required C3
Gidewalk Required 13
REQUIRED DEDICATION FT Underground [3
Wiring required C3
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NAME METER Sl F FIXTURES PRV REQUIRED
YES 13 NOE3 z
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t: ADDRESS LU
REMARKS z
U OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE E5
z
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CITY ZIP TELEPHONE
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NAME CBL# ;?� 0 Kffitml_
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9 16, 2,1 FIRE REVIEWED BY DATE
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ACENSLeNUMBER EXPIRATION DATE CHECKED BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION
REQ'D COMPLETED I EXEMPT
10YES 13NO
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PROPERTY TAXACCOUNT PARCEL NO. 2z CA# ZONE SIGN AREA HEIGH
WAIVER 0 ALLOWED ROPOSED ALLOWED PROPOSED
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NEW RESIDENTIAL PLUMBING if MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
X ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR 0
F] COMMERCIAL COMPLIANCE OR z
ADDITION E
CHANGE OF USE
MIXED USE PARKIN LOT AREA PLANNING REVIEWED BY DATE
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REMODEL MULTIFAMILY SIGN REQ'D PROVIDED
REPAIR E] GRADING CYDS FENCE X FT.) REMARKS
DEMOLISH TANK
GARAGE o RETAINING WALL FIRE SPRINKLER
z CARPORT ROCKERY FIREALARM
(TYPE OF USE, BUSIN5JS OR ACTIVITY) EXPLAIN:
TYPE OF CONSTRUCTION CODE OCCUPANT
GROUP
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NUMBER NUMBER OF 9PECIAL INSPECTION CONSULTANT OCCUPANT
D ELLING
Ci OF W
W STORIES UNITS LOAD
0 QUIRED DYES
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DESCRIBE WORK TO BE DONE
REMARKS
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BY:
STRUCTURAL DESIGN
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e,4' 3 0 4r 44-rL Description FEE Description FEE
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Plan Check State Surcharge C2
HEAT SbURCE LOTSLOPE% VESTED DATE
D Building Permit City Surcharge A
PLAN CHECK NO: Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLYJHE 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.
Endr. Review
PERMIT APPLICATION: SEE ECDC 19.00,005(A)(5)
Uj
PERMIT LIMIT: SEE ECDC 119.00.005(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
U)
Uj 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 #
0: 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 Landscapelnsp. Total Amt. Due
01 NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee L Receipt #
11 1
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 Fees 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
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27. URE 'ATE
�9�fl�IALS G AT
F�'
Z
SIGNATU;E t(WNER R AGETI, DATE SIGNED
(425)
771-0220 D/MFE
JL R'ELEAEfED SY
ATTENTION 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- ORIGINAL -FILE YELLOW -INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 I IRC1110- PINK -OWNER GOLD ASSESSOR
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