20050334.pdfDATE RECEIVED I , >
PERMIT EXPIRES
CITY OF EDMONDS NUM BER��� =/
CONSTRUCTION PERMIT APPLICATION JOBS ITE/APT#
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OWNER NAMEINAME OF BUSINE
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Street Use Pcrmn Regmratl 13
CITY ZIP TELEPHONE EXISTING PROPOSED Inspection Required O
` (� Sidewalk Required I7
$•Z� • �) ��L' 7 ` I3 REQUIRED DEDICATION FT _ underground O
Waing required - O
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
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ADDRESS OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE _
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NAME
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STATE LICENSE NUMBER EXPIRATIO D TE CHECK
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PROPERTY TAX ACCOUNT PARCEL NO.
00936`13 --001 -106 -00
❑ NEW ❑ RESIDENTIAL ❑ PLUMBING / MECH
❑ COMMERCIAL COMPLIANCE OR
❑ ADDITION ❑ CHANGE OF USE
❑ MIXED USE
REMODEL MULTIFAMILY ❑ SIGN
❑❑ GRADING ❑ FENCE
REPAIR CYDS ( X �
❑ DEMOLISH ❑ TANK ❑ OTHER
GARAGE RETAININGFIRE ❑ CARPORT ❑ ROCKERY. WALL ❑ FIRE ALARM LER
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PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
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FRONT UR SIDE REAR
PARKING
LOTAREA
PLANNING REVIEWED BY
DATE
REQ'D P IDED
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a(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
a �OD TYPE O,F XNSTRU,C/JTIIQ�r,;(OD OCCUPANT
v � I • 12 �5��'' • �C �� GROUP
cNUMBER NUMBER OF
OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
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STORIES UREQUIRED E3 YES
NITS LOAD
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DESCRIBE W09K TO BE DONE -{—
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insfaw�cr Mr GEOTECH REPORT
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Description FEE Description FEE
Plan Check Slate Surcharge • r
HEAT SOURCE LOT SLOPE% VESTED DATE 1
Building Permit City Surcharge
PLAN CHECK NO:/;�^ I Plumbing Base Fee r
THIS PERMIT AUTHORIZES ONLY THE WOOJRKKN—OTTED. THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION, Er1gf. Review
w PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
a PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engf. Inspection
,n Fire Review Plan Chk. De osit
w *APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS p
w 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 #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE r 1
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. DueIt
O NOR. LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.•
x
Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT 1 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 hislher Deputy: and Fees are paid, and
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 receipt is acknowledged in space provided.
WORKMEN'S SATION INSURANCE AND RCW 18:27, OFFICIALS SIGNATURE DATE
SIGNATU ( WNE ENW . DATE SIGNED (425) r v
. 771 =0220 BY ` DATE
ATTENTIOA V EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADEAND APPROVAL OR A CERTI- ORIGINAL - FILE YELLOW - INSPEC OR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1091 IBC1101 IRC1106 PINK -OWNER • GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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