20050359.pdfDATE RECEIVED I _ —
�� PERMIT EXPIRES
ERMIT 4 I -�'
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB
ADDRESS SUITE/APT#
O/y{,�NERR NAMEINAME OFF BUSINE�S?
eLtoo1i) C PLAT NAMEISUBDIVISION NO. LOT 140. LID NO.
LU MAILING ADDRESS LID FEE $
r - TESCPApproved O
3 / PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required O
O ,A/1 Cie .J �/ / I Street Use Permit Required
CITY ZIP TELEPHONE EXISTING PROPOSED Inspection Required O
r ' Sidewalk Required 0
�y Underground 0
!� ,� (i REQUIRED DEDICATION FT _
i Q Wiring required O
NAMt METER SIZE LINE SIZE NO. ORFIXTURES I PRV REQUIRED
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YES13 NO13 z
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ADDRESSREMARKS w
L) OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE. z
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FIRE REVIEWED BY DATE Lu
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STATE LICENSE NUMBER I EXPIRATION DATEJ D BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
NJ A// C ,y Iii [REQ'D COMPLETED EXEMPT
W j ! I "rJ� 3 J f V(IF X %' YES 0 NO
PROPERTY TAX ACCOUNT PARCEL NO. CA# ZONE SIGN AREA HEIGHT
a WAIVER ALLOWED PROPOSED ALLOWED PROPOSED
LU 0000020000 STUDY O 1'"'� I'�j N t:' NCS
❑ NEW ❑ RESIDENTIAL❑ PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
❑ COMMERCIAL COMPLIANCE OR
❑ADDITION
❑ CHANGE OF USE 1 z
❑ MIXED USE PARKING LOTAREAPLANNING REVIEWED BY DATE g
❑ REMODEL MULTIFAMILY ❑ SIGN REQ'D PROVIDED
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GRADINGFENCE
REPAIR ❑ CYDS ❑ ( X FT.) REMARKS w;
❑ DEMOLISH 1:1 TANK ❑ OTHER
GARAGE RETAINING WALL FIRE SPRINKLER ~� L+�r 4
z ❑ CARPORT ❑ ROCKERY ❑ FIREALARM
a (TYPE OF USE, BUSINESS O CTIVIT EXPLAIN;
TYPE OFACONSTRUCTION CODE OCCUPANT
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C' OF DWELLING YfRE
NSPECTION CONSULTANT OCCUPANT
p STORIES UNITS O LOAD
-a D 13YES
DESCRIBE WORK TO BE DONE
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Description FEE Description FEE
Plan Check ,r State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE /
Building Permit ! �GI City Surcharge /S
PLAN CHECK NO: Plumbing Base Fee \
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO MCChanICBI
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION. Engf. 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 EngL In6peCl10n
ur Fire Review Plan Chk. Deposit '
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS p
U) 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 #qj
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. Duo L
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I 11AVE 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 nal d purnut until signed by the
THE OWNER. 1 AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUc. CALL Budding Official or hlslhur Deputy and Foos are paid, and
TION; AND IN DOING TN ORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF TH FOR INSPECTION
BOR CODE OF THE STATE OF WASHINGTON RELATING TO rocuipl Is ecknowladged In space provided
WORKMEN'S COMPE 10 NSURANCE AND RCW 16:27,
OFFICIALS SIGNATURE: DATE /
SI UR WNE R ENT): ) DAT SIGNED / (425)
/ 771 '0220 RELEASED BY D TF.
TE IO EXT. 1333 C j .
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL -FnE YELtOW-INSpLL'RM
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC1091 IBC110 / IRC110. PINK wNIE o GOLD • ASSESSOR
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