20050229.pdfj_APArDATE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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CITY
NAME
Ale5
ADDRESS
5MV111,J46
STATf LICENSE NUN
4-651,761
NEW
ADDITION
REMODEL
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REPAIR
DEMOLISH
GARAGE
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ZIP I TELEPHONE
ZIP I TELE
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1-130
Av 6-N ile Al 6,
ZIP TELEPHONE
679 114 0 E� - (-4c? j
PERMIT EXPIRES
PERMIT
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PLAT NAMEISUBDIVISION NO.
LOT NO.
I
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPApproved
13
RW Permit Required
Street Use Permit Required
EXISTING PROPOSED
Inspection Required
E3
Sidewalk Requited
E3
REQUIRED DEDICATION
FT
Underground
E3
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METER SIZE
LINE SIZE
0. OF FIXTURES
PRV REQUIRED
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FIRE REVIEWED BY
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RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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DATE
DATE
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VARIANCE OR CU
SHORELINE OR ADB#
I INSPECTION
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EXPIRATION DATE
CHECKED BY
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ALLOWED PROPOSED
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ALLOWED PROPOSED
INT PARCEL NO.
STUDY 13
RESIDENTIAL
PLUMBING ir MECH
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBAC . KS (FT.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
FRONT L/RSIDE REAR
COMMERCIAL
COMPLIANCE OR
MIXED USE
CHANGE OF USE
PARKING
LOTAREA
ANNINGREVIEWED BY D E
MULTIFAMILY
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SIGN
REO'D PROVIDED
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GRADING
FENCE
CYDS
( X FT.)
REMARKS
TANK
OTHER
RETAINING WALL
FIRE SPRINKLER
ROCKERY
FIREALARM
:SS OR ACTIVITY) EXPLAIN:
TY OF CONS
In TYUCTION
CA-i.;_7
OCCUPAN
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NUMBER
OF '_rWo
NUMBER OF
DWELLING
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SPECIAL INSPECTION
CONSULTANT
OCCUPAF4T
S TORIES
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REQUIRED
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
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GEOTECH REPORT
BY:
REPLAC& ANY hAMPIrG-Eb PLYW006
STRUCTURAL DESIGN
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VALUATION
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Description
FEE
Description
FEE
X�IV3T4 L
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[an Check
State Surcharge
HEAT SOURCE
LOT,SLOPE%
VESTED DAI L
Building Permit
Plumbing
�2
City Surcharge
x
Base Fee
PLAN CHECK NO:
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Grading
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
Engr. Review
SEPARATE PERMISSION.,
r PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
Engr. Inspection
u
L PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
f) S
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSOR
Fire Review
Plan Chk. Deposit
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 #
cE ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
r FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
0 CE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINAN
Landscapelnsp.
Total Amt. Due 417119
_1
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
Recording Be
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.
IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
CALL
Building Official or his/her Deputy: and Fees are paid, and
TION; AND
OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt is acknowledged in space provided.
IN VIOLATION
WORKMP'S COMPEN SATIOIffSU RANCE AND RCW 118:27.
.4.
0 IALSSI�YAJURE DA E
SMIGN (OWNER 0 T): DATE SIGNED
(425)
771-0220
RELEASED BY DAT
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 / IRC110-
PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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