20050207 (2).pdfr.
DATE RECEIVE „r .
PERMIT EXPIRES
CITY OF EDMONDS NUBER��)�j .=.�
CONSTRUCTION PERMIT APPLICATION pDRES l UITEIAP
OWNER NAMEINA OF BUSINESS r
IIl r PLAT NAMEISUBDIVISION NO. LOT LID NO.
MAILING ADDRESS 1 LID FEE $
2 �= f PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RWTESCP
Permit Required
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✓ II \ L RW Permit roved tl
Street Use Permit Required 17
CITY ZIP TELI PHONE EXISTING _ PROPOSED _ Inspection Required O
'1 Sidewalk Required 0
Underground E3
REQUIRED DEDICATION _,_ FT Witing required O
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
45• / / YES O NO O z
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REMARKS w
�OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE z
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CITY ZIP/ TELEPHONE
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`L71 SL' ENGINEERING REVIEWED BY DATE
ADDRESS
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FIRER BY DATE w
CITY /} ZIP TELEPHONE �- r ter. �'� x
STAT LICENSE NUMBER EXPIRATIOND T C CKED 8 VARIANCE OR CU SHORELINE OR ADBp INSPECTION SEPA
�_ ~—• 113 YESO D NOCOMPLETED EXEKQ ��Z 1
CA# ZONE SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO.
�•� l� � .' .�� � WAIVEP�� ALLOWED PROPOSED ALLOWED PROPOSED
C STUDY O
NEW ❑ RESIDENTIALep�yp MECH LOT COVERAGE I REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
dCOMMERCIAL COMPLIANCE OR r---�"' '�z
❑ ADDITION ❑ CHANGE OF USE ?
❑ MIXED USE PARKING LOTAREA PLANNING REVIEWED BY DA
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REQ'D PROVIDED
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GRADING FENCE,
❑ REPAIR ❑ CYDS ❑ ( X FT.) REMARKS
❑ DEMOLISH ❑ TANK ❑ OTHER
GARAGE RETAINING FIRE ❑ CARPORT ❑ ROCKERY WALL ❑ FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
. L4 64 4 y TYPE ONSTRUCTION C DE GROUPOCC I
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NUMBER % NUMBER OF
OF DWELLING N SPECIAL INSPECTION CONSULTANT OCCUPANT
STORIES UNITS LOAD J � 74 ,
REQUIRED YES / �J`
DESCRIBE WORK TO BE DONE
REMARKS z
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0
GEOTECH REPORT m
11 BY:
C J rFzwi /I !ai STRUCTURAL DESIGN
BY:
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VALUATION
Description FEE Description FEE
Plan Check Slate Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE oz
!j Building Permit / City Surcharge
PLAN CH CK NO: ti Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBIC
E DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION,
Engr. Review
pr PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
> PERMIT LIMIT: SEE ECDC 19.00.005(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
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF _
Y EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspectioh / 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 i
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 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 in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27, OFFICIAL SIGNATURE DATE
SIGNATURE (OW O ENT):-) DATE IGNE (425)
D 771 -0220 SED BY DATE
ATT TION EXT. 1.333
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 - I SPECT R
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109 if IBC110 / IRC110. PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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