20050264 (2).pdf�I DATE RECEIVED fJ.
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
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CITY ZIP TELEPHONE Cil? +COY'
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NAME
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ZIP TELEPHONE
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IS
PERMIT EXPIRES
PERMIT V,Id' // r
NUMBER���j
JOB % SUITEIAPT#
ADDRESS ---
PLAT NAMEISUBDIVISION NO. LOT NO, LID NO.
LID FEE 5
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApproved O
RW Permit Required E3
Street Use Permit Required 0
EXISTING,_ PROPOSED Inspection Required O
Sidewalk Required 13
REQUIRED DEDICATION FT Underground O
Winn «. uirnd 0
METER SIZE LINE SIZE NO. OF FIXTURES I PRV REQUIRED
YES 13 NO O Z
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w
REMARKS W
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE _
W
ENGINEERING REVIEWED BY
DATE
- FIRE REVIEWED BY DATE
z CITY ZIP TELEPHONE it
STATE LICENSE NUMBER PIRATION DATE CED BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
REQ'D COMPLETED EXEI IPT
;S Y/V '— / —� 13YES O
CA# ZONE SIGN AREA HEIGHT
a PROPERTY TAX ACCOUNT PARCEL NO.
_ WAIVER ALLOWED PROPOSED ALLOWED PROPOSED
d <: So 62 OCA STU
❑ NEW ❑ RESIDENTIAL PLUMBING I MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
. X ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR
COMMERCIAL COMPLIANCE COMPLIANCE OR i
❑ ADDITION9MIXED USE ❑ CHANGE OF USE z
❑ ❑ PARKING LOTAREA PLANNING REVIEWED BY DATE g
REMODEL E] MULTIFAMILY
SIGN REQ'D PROVIDED 1 6 12 IL
FENCE P I �—
❑ REPAIR ❑ GRADING CYDS ❑ ( X FT.) REMARKS
❑ DEMOLISH ❑ TANK ❑ OTHER
GARAGE
_ ❑ CARPORT ❑ RETAINING
RO KERY WALL FIRE ❑ FIREALARM LER
d(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: , �•y1 &;Lz
V% ✓l raC4 /! U Z,��f .�y TYPE OF CONSTRUCTION CODE OCCUPANT
0 U C.i ( �-�,� GROUP
w NUMBER WIMBER OF
OF 3 6 6 v DWELLING G ry SPECIAL INSPECTION CONSULTANT OCCUPANT
0 STORIES �, Lu�C{ UNITS v b - LOAD
71 YES
DESCRIBE WORK TO BE DOME V. REQUIRED
REMARKS I z
%fid 01VI dk7 01 GEOTECH REPORT [ ����JJ yj
/BY: Jfi� ,(1 ' (! a
-/L4/'l LLhlfij STRUCTURAL DESIGN
BY:
�ol-L1 euist VALUATION
ti CLs't r� %y1 / to Z`C %1lj ! $ x��
(il6oixheyh.o Description FEE Description FEE
Plan Check 1 State Surcharge Jl�
HEAT,SpURC LOT SLOPE% VESTED DATE
f kL
L G Building Permit City Surcharge l
rte �C
LAN CHECK NO: Plumbing Base Fee
e- .. j
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical / Jl
BE DONE. ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
. ' J DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
Lu PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
a 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 t w
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 #
C ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
= FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE
OJ 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 At
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 permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
.TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building receipt
i or acknowledged
Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION rocoipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27,
OFFICIALS SIGNATURE /7 DATE
SIGNATURE JOWt4EIR OR GENT): DATE SIGNED (425)+IS
/�
\I �� 171 =0220 R SED BY `1 ,1 v` DATE
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 - IN PECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC1091 IBC110 / IRC110. PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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