20050343.pdfDATE RECEIVED
PERMIT
CITY OF EDMONIDS NUMBER
CONSTRUCTION PERMIT APPLICATION JADDRESS
OWNER NA�M7EINAME OF BUSINESS
PLAT NAMEISUB ISI
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CITYIZIP'1 TELEPHONE EXISTING A
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STATE LICENSE LICENSE NUMBER EXPIRATION DATE NNE KOff BY
Q PROPERTY TAX ACCOUNT PARCEL NO.
110;24o0410q$00
❑ NEW 113' RESIDENTIAL G;KPLU ING 1ECH
1:1COMMERCIAL C L NCE OR
❑ ADDITION 1:1C N F USE
El MIXED USE
�y REMODEL ❑ MULTIFAMILY SIG
❑ REPAIR ❑ GRADING ❑ N
CYDS ( X FT.)
❑ DEMOLISH ❑ TANK ❑ OTHER
❑ GARAGE ❑ RETAINING WALL ❑ FIRE SPRINKLER
PERMIT EXPIRES
SUITErAPT#
N LOT NO. LID NO,
LID FEE S
SER OFFICIAL. STREET MAP TESCP Approved ❑
RW Permit Required ❑
Street Use Point Requited ❑
PROPOSED _ Insitmeon Requited ❑
Sidewalk Required ❑
FT Underground ❑
Weinrequired ❑
LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES O NO CI _
LU
W
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RESPONSIBLE FOR EROSION CONTROLJDRAINAGE _
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ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE W
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VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
REO'D I COMPLETED I EXEMPT
113YES NO
CA# Cx0' S ZONE SIGN AREA HEIGHT
WAIVER CI , ALLOWED PROPOSED ALLOWED PROPOSED
STUDY. , 2 G ti ZO
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L(R SIDE REAR O
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2
PARKING LOT AREAPLANNING REVIEWED BY DAT g
REO'D PROVIDED 13r I s r 9 `
41iEMAWRKS
Z CARPORT ROCKERY FIREALARM
F . (TYPE OE USE, BUSINESS Olj ACTIVITY) EX f IN. ?
U L'lft�i L �►/i` ��j.�] `+�L TYPE OFCUCTION CODE GROUP OCCUPANT
Uri
NUMBER IV NUMBER OF
OF 2 DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
OSTORIES UNITS LOAD
DESCRIBE WORK TO BE DONE REQUIRED YES
REMARKS _
• Mo U, EWWA IR`U!
GEOTECH REPORT m
BY:
STRUCT Q��
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BY: ! � 1v
VALUATION
1) lox
'! Description FEE Description FEE
Plan Check Slate Surcharge S�
HEAT SOURCE J LOT SLOPE°iu VESTED DATE
4' Building PermitqO City Surcharge 1,
PLAN CHECK NO:`—' ,� Plumbing '"l " Base Fee r-
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO Mechanical `~
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC Grading
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC,) WILL REQUIRE g
SEPARATE PERMISSION, Engf. Review
cc 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
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire R@VIEW Plan Chk. Deposit L
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
= FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE
45
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due
r
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.•
Recording Fee Receipt #
1 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 perrml until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC•
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, 110 PERSON WILL BE,EMPLOYED CALL Building Official or his/her Deputy and Foes are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged in space provided
WORKMEN'S C SATION INSURANCE AND RCW 18:27.
O JCIALS SIG URE DATE
SIGNATURE ( NE R AGENT): DATE SIGNEDl4 % $ r0 r 771 0 20 RS D BY / DATI!
ATTENTION EXT. 1333al
J0
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL ` L �)
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGIN L • FIL YELLOW • INSPECT R
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 I IBC110 I IRC110. PINK 'OV ER GOLD • ASSESSOR
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