20050203.pdfDATE RECEIVED,
[PERMIT EXPIRES
PERMIT
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB _7 Y6,) SqE/JVP#
ADDRESS
OWNER NAMMNAME OF BUSINESS
PLAT NAMEISU BDIVI SION NO. LOT NO. LID NO.
MAILING ADDRESS
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApproved 0
RW Permit Required (3
Street Use Permit Requited [3
CITY ZIP TELEPHONE EXISTING PROPOSED Inspection Requited 0
4t:�? / 1, Sidewalk Requited [3
174 7 Aa 16L,03 REQUIRED DEDICATION FT Underground 0
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N AME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
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DATE
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EXPIRATIO�-DATE CHECKEV13Y REO'D COMPLETED I EXEMPT
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ADDITION COMMERCIAL COMPLIANCE OR z
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E3 MIXED USE PARKING LOTAREA PLANNING REVIEWED BY DATE
REMODEL MULTIFAMILY SIGN REQ'D I PROVIDED
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x FT.) REMA RKS
OTHER
DEMOLISH TANK
z E]GARAGE RETAINING WALL FIRE SPRINKLER
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GEOTECH REPORT
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BY:
VALUATION
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Description FEE Description FEE
f ZIA 0/ AL4 n Check State Surcharge
HEAT SOURCE LOTSLOPE% VESTEDDATE I
Building Permit City Surcharge
PLAN CHECK NO: Plumbing Base Fee
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 jCURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5) Engr. Review
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
U)
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_j 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 H
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
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0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO. ENFORCE ANY ORDINANCE PROVISION.' ?'5
MI Recording Fee Receiat # I
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 nota permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building Off icial or his/her Deputy: and Feesare 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 COM PEN SA;Pbdllilli� RANCE AND RCW 18:27. FIFICIALS SIGAATURE DATE
DATF—SIPNED IS
19NATU (OWNER 0 AG T. (425)
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j 771-0220 DI DATE
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RELF*
AfTE N"TION E XT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL,
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A GERTI- ORIGINAL - FILE YELLOW - INSPECTOf
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110. PINK -OWNER GOLD ASSESSOR
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