20050377.pdfDATE RECEIVED —�
PERMIT EXPIRES
CITY OF EDMONDS NUMBER �2.�U5 3 i _
CONSTRUCTION PERMIT APPLICATION JOB DOREssq6(ctA SUITE/APT#
OWNER N EINAME OF BUSINESS
2, �,� �� PLAT NAMEISUBDIVISION NO. LOT NO, k JID NO
LEW
MAILING ADDRESS ` LID FEE $
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3 1 TESCP Approved 0
O !/hCG "!. L PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permd Require] O
Sheat Use Vermd Required E3
CITY ZIP TELEPHONE EXISTING PROPOSED Inspechon Required 13
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% Siduwalk Required 0
7 Underground 0
I!`it S %%/ l .J REQUIRED DEDICATION FT Mind required 0
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
t_ YES O NOD z
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ADDRESS REMARKS W
L) OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE z
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ADDRESS
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STATE LICENSE NUMBEREXPIRATION DATA CHECKED BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
// f:i�.4 C6 REQ'D COMPLETED EXEMPTD YES ON
> 0 NO
PROPERTY TAX ACCOUNT PARCEL NO. W ICA# ZONE SIGN AREA HEIGHT
II/^�% n WAIVER D ALLOWED 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 LIR SIDE REAR
❑ COMMERCIAL COMPLIANCE OR z
❑ ADDITION ❑ MIXED USE ❑ CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY DATE g
❑ REMODEL El MULTIFAMILY ❑ SIGN REQ'D PROVIDED
❑ REPAIR❑ GRADING CYDS ❑ FENCE X FT.) REMARKS
❑ DEMOLISH ❑ TANK OTHER
❑GARAGE RETAINING RE
CARPORT ❑ ROCKERY WALL ❑ FIREALARM SPRINKLER
a t TYPE OF ONSTRUCTION OCCUPANT
v 1 � CODE GROUP
w NUMBER NUMBER OF
o OF DWELLING SPECIAL INSPECTION CONSULTANTTLOCACDU
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p STORIES UNITS
71 DESCRIBE WORK TO BE DONE REQUIRED 13YES
REMARKS
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GEOTECH REPORT
BY:
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VALUATION
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/g6L411d1tCD0L Description FEE Description FEE
Plan Check State Surcharge
HEAT SOUR E LOT SLOE o VESTED DATE _
Building Permit City Surcharge
PLAN CHECK NO: Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBIC Gradin
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC,) WILL REQUIRE g
SEPARATE PERMISSION. Engr. Review
LU 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 Engr. Inspection
m 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
Uj IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
C 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 I /
=
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.' e
Recording Fee Receipt # V66076
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 Official or his/her 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 COMPENSATION I NCE AND RCW 18:27, O I ALS Si GNATU DATE
S DAT ED (425)
? �l 771 -0220 RELEAS BY DA E
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- ORIGINAL -FILE •YELLOW -INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC1091 IBC110 I IRC1109 PINK -OWNER • GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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