20050298 (2).pdfDATE RECEIVED
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7- PERMIT
CITY OF EDMONDS NUMBER���
CONSTRUCTION PERMIT APPLICATION AJooREss , SUITErAPTP
OWNER NAME/NAME OF BUSINESS '
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(� P CFbC�fl �{ � &O�`.�/ , A . . 1� PLAT NAME/SUBDIVISION NO. LOT LID NO.
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^ / C -r PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved E3+d � S 1 t H 1` Y. C -q 45 u 1 � G+1 O3 RW Permit Renueed ❑
Street Use Permit Required ❑
CITY ZIP TELEPHONE EXISTING PROPOSED_ Inspection Required O
WMOt*1 �18b2� �S 1 `1 (AV3 � n7e Underalk ground Required ❑
REQUIRED DEDICATION FT UUnderground ❑
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NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
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ADDRESS REMARKS w
OWNEWCONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE iz
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ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
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STATE LICENSE NUMBER PI C CKED BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
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CA# ZONE SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO.
WAIVER O _ ALLOWED PROPOSED ' ALLOWED PROPOSED
STUDY 13
NEW RESIDENTIAL PLUMBING / MECHLOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
COMMERCIAL COMPLIANCE OR _
ADDITION MIXED USE
El CHANGE OF USE _
REMODEL O PARKING LOTAREA PLANNING REVIEWED BY DATE g
MULTIFAMILY SIGN REQ'D PROVIDED
0 REPAIR p GRADING CYOS ENCE X FT.) REMARKS
DEMOLISH TANK OTHER1.
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13 CARPORT
ROCKERY
WALL FIRE SPRINKLER,
CARPORT
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(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN.
Com{ .w�L.rf r L TYPE OF CONSTRUCTION CODE OCCUPANT
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r OF 1 DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
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t REQUIRED 0 YES
DESCRIBE WORK TO BE DONE
REMARKS z
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1 GEOTECH REPORT
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STRUCTURAL DESIGN
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V' Q`vZ ✓ VALUATION "
PES t l,.0 N �: l� t•� $ �
�M IT Description FEE Description FEE
Plan Check Slate Surcharge
HEAT SOURCE L T SLOPEio VESTED DATE / --�
a • .�V, 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
E DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC,) WILL REQUIRE g
J SEPARATE PERMISSION.
� Engr. Review
u 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
V) *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 r^ -� Receipt #
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 6
= NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Recording Fee Receipt # al ?�
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 AUT14ORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided
RKMEN'S COMPENSATION INSURANCE AND RCW 18:27. c OFFICIALS SIGNATURE DATE
SIGN RE (O ER G DATE IGNED a� (425)/ 1 K
771m0220 R 0 S _ DATE
TT TION 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 -INSPECT R
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 I IRC110, PINK -OWNER GOLD - ASSESSOR
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