20050309.pdfDATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER-UAMEINAME QE BUSINESS
PERMIT EXPIRES 1--4- 4- � �.L
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PERMIT
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JOB SUITEIAPTA
ADDRESS
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PLAT NAME/SUBDIVISION NO. LOT NO. LID NO
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MAILING ADDRES
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3: ') 0 e 1, 3 , PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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Street Use Permit Required 13
CITY ZIP TELEPHONE EXISTING PROPOSED Inspection Required [3
Sidewalk Required E3
REQUIRED DEDICATION FT unaot9found 0
required 13
41NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
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OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIORAINAGE
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PROPERTY TAX ACCOUNT PARCEL NO. CA# ZONE SIGN AREA HEIGHT
< WAIVER 13 ALLOWED I PROPOSED ALLOWED PROPOSED
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NEW RESIDENTIAL PLUMBING MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
COMMERCIAL COMPLIANCE OR z
ADDITION MIXED USE El CHANGE OF USE I fJ& I —,I — A& 2
PARKING LOTAREA PLANNING REVIEWED BY DATE
REMODEL MULTIFAMILY El SIGN REO'D PROVIDED
GRADING FENCE
REPAIR CYDS x FT.) REMARKS
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DEMOLISH TANK 6
RETAINING WALL
GARAGE FIRE SPRINKLER
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(TYPE OF USE, BUSINESS QR.ACTIVITY) EXPLAIN:
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to SPECIAL INSPECTION CONSULTANT OCCUPANT
0 STORIES UNITS REQUIRED DYES LOAD
DESCRIBE WORK TO BE DONE REMARKS (9
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GEOTECH REPORT
BY:
STRUCTURAL DESIGN
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VALUATION
Description FEE Description FEE
Plan Check State Surcharge
HEATSOURCE LOTSLOPE% VESTED DATE
Building Permit City Surcharge
CHECK NO: Plumbing Base Fee
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
t- BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
i DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE Grading
t= SEPARATE PERMISSION.
2- Engr. Review
M PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
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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
Lu IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
0: CTLY OR INDIRECTLY
4 ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRE
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 Landscapelnsp. Total Amt. Due
0 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 Officral or hisihor Deputy: and Foos are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED receipt is acknowledged in space provided
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27. OFFICIALS SIGNATURE DATE
NED
DATE Stir'
SIGNATU (OWNERORAG7f)V: (425)
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_C L DATE
ATTENWOf4 EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 711 il� blW1411)
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL - FILE YELLOW INSPECTOfi
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110. PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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