20050272.pdfDATE RECEIVED / '1
Ll ! PERMIT EXPIRES
CITY OF EDMONDS NUMSER
CONSTRUCTION PERMIT APPLICATION JOB / SUITEIAPT#
OWNER NAMEINAME OF BUSINESS ADDRESS
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_TESCP Approved E3O C, ' 4 C L ' I ` PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW PermitRequiredE3l Street Use Permit Required ❑
CITY ` ZIP TELEPHONE C L`Z) EXISTING PROPOSED Inspection Required ❑
Sidewalk Required E3REOUIREDDEDICATION FT Underground E3�imv n
Worn required ❑
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
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YES El NO O Uj Luz
t= ADDRESS REMARKS w
UOWNERICONTRACTORRESPONSIBLE FOR EROSION CONTROUDRAINAGE z
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STATE LICENSE NUMBER EXPIRATION D TE C CKE BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
REO'D COMPLETED I EXEMPT
n O j d 13 YES 13NO
Q PROPERTY TAX A/C�COUNJLP CE CAN ZONE SIGN AREA HEIGHT
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ALLOWED PROPOSED ALLOWED PROPOSED
❑ NEW 00�RESIDENTIAL ❑ PLUMBING I MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR t,
❑ COMMERCIAL COMPLIANCE OR _
❑ ADDITIONElMIXED USE ❑ .CHANGE OF USE z
PARKING LOT AREA PANNING REVIEWED BY DATE g
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REO'D PROVIDED
E]❑GRADING ❑ FENCE X FT.) REMARKS
REPAIR CYDS
1:1 DEMOLISH ❑ TANK 1:1GARAGE OTHER
z ❑ CARPORT ❑ ROCKERY RETAININGWALL ❑ FIRE A ARM FIRE LER
a (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
`' \ rJ TYPE C N T ION D OCCUPANT
v ` C J GROUP
CNUMBER NUMBER OF
OF DWELLING 1 SPECIAL INSPECTION CONSULTANT OCCUPANT
O STORIES UNITS 11 LOAD
0 REQUIRED. 13YES
DESCRIBE WORK TO BE DON
REMARKS i
GEOTECH REPORT m
BY:
1ti STRUCTURAL DESIGN
BY:
VALUATION
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Description FEETDescriptioEn FEE
Plan Check ate SurchHEAT SOURCE LOT SLOPE% VESTED DATE ��Building Permit ty Surcharge
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 Grading
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g
.j SEPARATE PERMISSION, L
Engr, Review
it I Lu
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
o PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection
in *APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire ROVIBW Plan Chk. Deposit
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IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
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ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscape Insp. Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
= 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 ODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged to space provided.
WORKMEN'S COMPENSATI NCE AND RCW 18:27. OFIXIALS SI NATURE DTE
DATE SIGNED _ e� /
SIGNATURE (OWNE OR E T): C" ( (425) /� I t)L)
771 -0220 RELEASEW61' TE
ATTENTION EXT. 1333
IT IQ uNli AWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A F!NAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL -FILE YELLOW - INSPECTOF
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 I IBC110 I IRC110, PINK -OWNER • GOLD - ASSESSOR
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