20050278.pdfDATE RECEIVED PERMIT EXPIRES
PERMIT
CITY OF EDMONDS NUMBER t9 7�
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
ADDRESS,!q
OWNER NA—ME/NAME OF BUSINESS 7,71.6 ;�
L.— . PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
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CITY ZIP TELEPHONE
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NAME
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STATE LICENSE NUMBER EXPIRATION DATE I CHECKED BY
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LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP ApproZed
RW Permit R
Street Use Permit Requited
13
EXISTING PROPOSED
Inspection Required
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Sidewalk Required
13
REQUIRED DEDICATION _.-- FT
Underground
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METER!
IZE —70.
OF FIXTURES
PRV REQUIRED
YES 13 NOO
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REMARKS
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OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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NEW RESIDENTIAL PLUMBING if MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR M
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ADDITION COMMERCIAL COMPLIANCE OR z 0
MIXED USE CHANGE OF USE z 0 C
DATE 5
PARKING LOT REA I PLANNING REVIEWED BY 0.
REMODEL El MULTIFAMILY El SIGN REQ'D PROVIDED MM
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FIRE REVIEWED BY
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REPAIR
DEMOLISH
CARPORT
GRADING
CYDS
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ROCKERY
FENCE
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FIRE SPRINKLER
FIRE ALARM
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REMARKS
(TYPEOFUSE,B INESS OR ACTIVITY XPLAJ.N
TYPE OF COtijaIRUCTION
NUMBER NUMBER OF
OF DWELLING
SPECIAL INSPECTION
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STORIES C91, UNITS
REQUIRED E3 YES
DESCRI13E WORK TO BE DONE
REMARKS
GEOTECH REPORT
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Description
Plan Check
HEAT SOURCE
LOT SLOPE%
VESTED DATE
Building Permit
PLAN CHECK NO:
Plumbing
4
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
.
Grading
DONMAIN (CUR BS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
Engr. Review
SEPARATE PERMISSION.
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
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Fire Inspection
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapeinsp.
DEEMED
NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
Recording Fee
IHE . REBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
THE OWNER. I AGREE
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
IN VIOLATION OF
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
(425)
'MM—ATL RE (OWNER
ATEbMNED
771-0220
111L.Nif:1
CODE OCCUPAR
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3ULTANT OCCUPANT
LOAD
FEE Description
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due cc)
.4( Ll 1,
Receipt # i .
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or hisitior Deputy: and Fees are paid. and
receipt is acknowledged in space provided.
IGNATUREo... tIATElt ii
RELEASED PN I
ATTENTION Al. 1*2
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1091 IBC110 if IRC110.
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FINAL PR03ECT APPROVAL FORM
RECORD OF INSPECTIONS