20050181.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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W MAILING ADDRESS
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CITY ZIP TELEPHONE
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ADDRESS
NAME
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ADDRESS
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[PERMIT EXPIRES l� y
PERMIT I
NUMBER-.
JOB SUITEIAPT#
ADDRESS 7012 /M 6*i wu)vAt� - u Rp.
PLAT' NAME/SUBDIVISION NO, LOT NO LID NO,
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApproved I
RW Permit Required
Sheet Use Permit Required
EXISTING PROPOSED Inspection Required I
Sidewalk Required 1
REQUIRED DEDICATION _ FT Underground 1
- Weinre cared I
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES O NO O
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERI 1kyj WEMY`u`' '" a DAT
(� � � r3 � • on1�fuel-burning appliances passing
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= CITY ZIP TELEPHONE �'""` -':-' �
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STATE LICENSE NUMBER EXPIRATION DATE C y VARIANCE OR CU SHORELINE OR ADB# INSPECTION . SEPA
�` ,y �/� REQ'D COMPLETED EXEMPT
�o 0 L/ � � I�� O YES I3 NO
CA# ZONE SIGN AREA HEIGHT
a NOD ALLOWED PROPOSED
PROPERTY TAX ACCOUNT PARCEL . 7 %
CSC% J eOo Loi'✓�/1 STUDY O WAIVER ALLOWED PROPOSE
�pLUMBING MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
1:1 NEW RESIDENTIAL
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR
❑ COMMERCIAL COMPLIANCE OR z
❑ ADDITION ❑ 13MIXED USE CHANGE OF USE z
❑ . PARKING LOTAREA PLANNING REVIEWED BY DATE
❑REMODEL S
MULTIFAMILY 1:1 SIGN REO'D PROVIDED
GRADING FENCE
El REPAIR ❑ CYOS ❑ ( X FT.) REMARKS
❑ DEMOLISH ❑ TANK 13OTHER
Z ❑GARAGE RETAFIRE
CARPORT ❑ RO KIERYG WALL 1:1FIREALARM SPRINKLER
a(TYPE OF USE, BUSINESS OR ACTI Y)
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TY CON$�R ION D[� JOCCUPANT
GROUP
Lu NUMBER NUMBER OF
OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
O STORIES UNITS LOAD
REQUIRED 0 YES
DESCRIBE WORK TO BE DONE
REMARKS, z
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GEOTECH REPORT to
BY:
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/'•/�j'(/V STRUCTURAL DESIGN
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BY:
CrAehrE VALUATION
% le '/ Description FEE Description FEE .
Plan Check State Surcharge
AHf AT SOURCE LOT SLOPE% VESTED DATE
Building Permit City Surcharge �(
PLAN CHECK NO: Plumbing Base Fee r
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO MBChanIC2I
i BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBIC dl
fan
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L DONMAIN (CURBS• SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g
SEPARATE PERMISSION.
2 - - Engr. Review
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PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
a PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection
U)•APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan.Chk. Deposit
Ui 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
= 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 I Receipt # Ira 35 C
I HEREBY ACKNOWLEDGE THAT 1 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
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged n space provided.
WORKMEN'S COMPENSATIO SURANCE AND RCW 18:27. 0 IALSSIGN TURE ATE
SIGNAT (OWNER OR EN . DATE SIGNED (425)
�� `O✓ 771 -0220 RELEASED BY ,PIATE
ATTENItION 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, UBC109I IBC110 1 IRC110. PINK -OWNER GOLD ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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