20050283.pdfDATE RECEIVED L4
[P7ERMIT EXPIRES
CITY OF EDMONDS
PERMIT
NUMBER -3
CONSTRUCTION
PERMIT APPLICATION
JOB SUITEIAPT#
ADDRESS 17z7,O&
OWNER NAMEINAME OF BUSINESS
PLAT NAME/SU BDIVI SION NO.
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LID No.
LID FEE S
VA-ILING ADDRESS
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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TESCP Approved
RW Permit Required
93
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EXIST114G PROPOSED
street rise Pernia Required
inspection Required
13
CITY ZIP
TELEPHONE
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REQUIRED DEDICATION FT
Sidewalk Required
Underground
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NUMBER EXPIRATION DATE
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ENGINEERING
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CHANGE OF USE
MULTIFAMILY
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FENCE
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TANK
OTHER
RETAINING WALL
ROCKFRY
FIRE SPRINKLER
FIREALARM
ORACTIVITY)EXP I -
NUMBER
OF
STORIES
DESCRIBE WORK TO BE DONE
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WAIVER C3
STUDY 13
ED BY CITY INSPEMR
BE ACCEPTED
SHORELINE OR ADB11 I INSPECTION SEPA
REClD PLETED I EXEMPT
LOT COVERAGE "`141 "-REMIRED
ALLOWED PROPOSED I FRONT SIDE
REMARKS
PROPOSED
5_R05P_0S_Eb_S�TBACKS (FT.)
FRONT L/R SIDE REAR
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gre-q%iore/rendt vaives an appr,
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TYPE Ol� S RUCTIOI
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NUMBER OF
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tREMARKS
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GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
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VALUATION
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Description
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Plan Check
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VESTED DATE
Building Permit
PLAN dHECK NO:
Plumbing
Mechanical
THIS PERMIT AU77RIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Grading
Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT.' SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr.
Engr. Inspection
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
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 114DIRECTILY
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
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Fire Review
Fire Inspection
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Recording Fee
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
^00CrT AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
CODE OCCUPANT
^ �7 IGROUP
CONSULTANT OCCUPANT
I LOAD
GIVEN to U P - CALL
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
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
DAT,7S GNED (425)
SIGNAT9RE (OWNE 0 T
771-0220
cvlr 411,111
FEE Description FEE
State Surcharge
City Surcharge
0, m Base Fee �,?o,
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt # f)
APPLICATION APPROVAL
This application is not a permil until signed by the
Building Official or hisihor Deputy: and Fees ire paid, and
receipt is acknowledged in space provided
FICIALS GN RE DATE
LIEASN BA I I DATE
�TION WILDING OR STRUCTURE UNTIL
IT IS UNLAWFUL TO USE OR OCCUP A B
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110.
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK -OWNER GOLD - ASSESSOR
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