20050186A (2).pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
CITY ZIP TELEPHONE
NAME
ZIP
NAMES ( CBLN
rfLCU;140kW, 1.1.1. L < 7
ADDRESS
CITY ZIP TELEPHONE
STATE LICENSE NUMBER EXP RATION DATE 9dfCKED
PROPERTY TAX ACCOUNT PARCEL NO.
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❑ NEW ❑ RESIDENTIAL ❑ PLUMBING I MECH
COMMERCIAL COMPLIANCE OR
ADDITION `-tel ❑ CHANGE OF USE
❑ MIXED USE
REMODEL ❑ MULTIFAMILY ❑ SIGN
GRADING FENCE
❑ REPAIR ❑ CYDS ❑ ( X
❑ DEMOLISH TANK El OTHER
❑GARAGE FIRE SPRI
CARPORT ❑ RO KIF.RY NINGWALL 1:1FIREALARM LER
(TYPE OF USE, BUSINES4 OR ACTIVITY) EXPLAIN:
PERMIT EXPIRES
PERMIT
NUMBER,
JOB I SUITEIAPTH
ADDRESS U'I rt
L�
PLAT NAMEISUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPApproved
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13
RW Permit Roquurod
Street Uso Pormd Requited
13
EXISTING PROPOSED
Inspection Required
t3
_
Sidewalk Required
0
REQUIRED DEDICATION
FT
Underground
E3
13
Witing required
METER SIZE
LINE SIZE
NO. OF
FIXTURES
PRV REQUIRED
YES O NO O
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a
W
REMARKS
W
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OWNER/ NTRACTOR RESPONSIBLE
FOR EROSION CONTROLIDRAINAGE
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REVIEWED BY
FIRE REVIEWED BY
DATE
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VARIANCE OR CO SHORELINE OR ADB# INSPECTION SEPA + O
REO'D COMPLE'rE0 EXEh1PT
O YES ONO 10
CAN - J ZONE SIGN AREA HEIGHT f m
WAIVE ALLOWED PROPOSED ALLOWED PROPOSED
STUDY OLOT
COVERAGE
ALLOWED PRO PROPOSED REQUIRED FRONTSIDE ACREAR KS ) FRONT SELIR SIDECKREAR) ' v m
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PARKING LOTAREA PLANNING REVIEWED BY DATE g I —j n
REO'D PROVIDED I Q C
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g TYPE OF CON TRUCTION CO 1E -OCCUPANT N
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0 OF DWELLING �J /� SPECIAL INSPECTION CONSULTANT0 UPANT I —11
o STORIES UNITS (,�' L AD _ rb
REQUIRED 13YES I M M
DESCRIBE WORK TO BE 13ONE
REMARKS t7 I O Ui
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"tViiixG,G E('lijCLI GEOTECH REPORT m CCD
STRUCTURAL DESIGN r r r� n J� D c Z
k Sti VALUATION "BY: OVA dv I j} Vr1r X
IC. $ D
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Description FEE Description FEE Z
Plan Check State Surcharge 2
HEAT SOURCE LOT SLOPE% VESTED DATE .-.--
��--— Building Permit City Surcharge 0
PLAN CHECK NO: Plumbing Base Fee n
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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 Gradin
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g
SEPARATE PERMISSION, Ellgf. Review
W 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
y 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit _
LU 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 #
Q ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
z 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
2 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee Receipt # /l
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT 1 AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF This application Is not a pormd 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 Foes 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 m space provided
WORKMEN'S COMPENSATION INSURANCE AND RCW 10:27, FICI LS $JG AT RE DATE
SIGNAT' WWNNER OR E ): DATE SIGNED .` (425)
oft! / `'' `, 771m0220 RELEASED BY 9 TE
ATTENTION EXT. 1333
IT IS UNLAWFUL TO USE 046 CUPY 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 1 IBC110 I IRC110. PINK -OWNER • GOLD - ASSESSOR
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