20050232 (2).pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OW ER NAME/NAME 9F BUSINESS
MAILING ADDRESS T
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CI Y ZIP ITE PHONE
NAME
7 -<� I I PERMIT EXPIRES
PERMIT
NUMBER -
JOB SUITE/APTH
ADDRESS � �*' - � � , �.•.
PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApproved 13
RW Permit Required 0
Street Uso Pemut Required o_
EXISTING PROPOSED _ Inspection Regwrud O
—_ SKluwalk Required o
REQUIRED DEDICATION FT Underg,amd O
-- -- -- Winnrequired
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES O NO O z
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REMARKS w
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE Z
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NAME '� I rI CBLI
N� u 4��►��2 ENGINEERING REVIEWED BY DATE
IX ADDRESS
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CITY ZIP j/TELLS HONE
3TA-rr �CENS9 NUM-, EXPI TION'to I CHECKED BY VARIANCE OR CU SHORELINE OR ADIB11 SEPA
• -��` �/. / .REQ'D COMPLETED EXEMPT
114
�� V' OYES ONO
11111111MA 't CA# ZONE SIGN AREA HEIGHT
PROPS TY TAX ACCOUNT PARCEL NO.
WAIVER O ALLOWED PROPOSED ALLOWED PROPOSED
r STUDY O 9 /7
❑ 1s!( LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
NEW ❑ RESIDENTIAL PLUMBING / MECH
ALLOWED PROPOSED FRONT SIDE . REAR FRONT UR SIDE REAR t7
COMMERCIAL COMPLIANCE OR z
❑ ADDITION ❑ CHANGE OF USE
❑ MIXED USE PARKING LOTAREA PLANNING REVIEWED BY DATE g
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REQ'D PROVIDED
❑
GRADING FENCE REPAIR ❑ CYDS ❑ ( X FT.) REMARKS
❑ DEMOLISH ❑ TANK ❑ OTHER
Z ❑GARAGE RETAINING FIRE
CARPORT ❑ ROCKERY WALL E:] ROCKERY SPRINKLER
0
CL (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
�� TYP O STRUCT ON D OCCUPANT
u GROUP
W NUMBER NUMBER OF
OF DWELLING �J .� SPECIAL INSPECTION CONSULTANT OCC PANT
O STORIES UNITS �!� LOAD.
REQUIRED I YES
)RK TO
GEOTECH REPOKI
BY: `~ �•
STRUCTURAL DESIGN
BY:
VALUATION
Description FEE Description FEE
Plan Check Slate Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE
Building Permit City Surcharge L
PLAN CHECK NO; 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 Gradin
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEESt ETC.) WILL REQUIRE g
SEPARATE PERMISSION. Engr. RBVIBW
L 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
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
W IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
i EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #E
a 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
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee Receipt # l .0
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 hls/hor Deputy: and Fees are 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 COMP NSATION INSURANCE AND RCW 18:27. OFF S SIGN TU E - bATE.
SIGNAT (O A NT): DQE 9 NED (425) �,10
1)C>S 771-0220 RELEAS B D E
ATTEN ON 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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