20050363.pdfDATE RECEIVED
U, 10 ERMIT EXPIRES ( (.e 04.3
CITY OF EDMONDS NUMBER-G'Q5- C'3C�'
FCITY
STRUCTION PERMIT APPLICATION SUITE/APT#
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LID FEE $
�/G _PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApproved ❑RW Permit Required ❑ ZIP Tat 00 Street use Permit Required E3
HONE EXISTING PROPOSED inspection Required q ❑
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�%% O / �% 2 yZsr %VZ • yg•Sd REQUIRED DEDICATION FT underground
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NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
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ADDRESS Type l3 01" 1j Vent connectors required
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STATE LICENSE NUMBER EXPIRATION DATE BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
REQ'D COMPLETED EXEMPT
O At63 07U1164111 4p 0z ZL d 13YES 13NO
a PROPERTY TAX ACCOUNT PARCEL NO. CA# ZONE SIGN AREA HEIGHT
W /^ WAIVER O ALLOWED PROPOSED ALLOWED PROPOSED
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❑ NEW C3.RESIDENTIAL RLP ALLOWED / ECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
1. ALLOWED PROPOSED FRONT SIDE REAR FRONT` LIR SIDE REAR
13ADDITION ❑ COMMERCIAL COMPLIANCE OR z
❑ MIXED USE a CHANGE OF USE z
❑ REMODEL❑ MULTIFAMILY ❑ SIGN REQ'D ARPIROVIDED NG LOTAREA PANNING REVIEWED BY DATE g
❑ REPAIR ❑ GRADING❑ FENCE
CYDS ( X FT.) REMARKS
❑ DEMOLISH ❑ TANK ❑ OTHER
Z FIRE
❑ CARPORT ❑ R CKGARAGE RETAIERY NING WALL ❑ FIRE ALARM SPRINKLER
P. (TYPE OF USE, BUSINESS OR ACTIVITY) EXP IN:
U C TYP F CO U TION CODS OCCUPANT 1')
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GROUP K
ww NUMBER NUMBER OF
m OF DWELLING I SPECIAL INSPECTION CONSULTANT OCCUPANT
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DESCRIBE WORK TO BE DONE REQUIRED D YES
REMARKS
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GEOTECH REPORT 5
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STRUCTURAL DESIGN
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VALUATION
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Description FEE Description FEE
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1 Jo ' "�- � f IPI � Plan Check State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE
Building Permit City Surcharge
PLAN CHECK NO: Plumbing Base Fee 2
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
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
t SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
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a PERMIT LIMIT. SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION g . p
w 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
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
= ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY p. Receipt #
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
= NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION,* �r
Recording Fee Receipt # Z�
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
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• CALL This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees aro paid, and
IN VIOLATION OF THE LAB CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided
WORKMEN'S COMPENSAT NS RANCE AND RCW 16:27.
OFFICIAL SIGN JRE DATE
SIGNATURE (OWNER OR ENT): DATE SIGNED (425) P F�01 hmesP,/ I I) 1.
Ij a771 10220 RELEASED Y DAT
ATTENTION 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-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110. ORIGINAL - FILE YELLOW - INSPECTOR
PINK • OWNER GOLD • ASSESSOR
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