20050381.pdf17 �-N�
DATE RECEIVED
CITY OF EDMONDS.
CONSTRUCTION PERMIT APPLICAT
OWNER NAtv1E1NAME OF BUSINESS, n
CITY ZIP
NAME
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ADDRESS
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PERMIT EXPIRES
PERMIT Z
NUMBER ♦♦♦��C /� C-,/ .j
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PLAT NAME/SU BDIVISION NO. LOT NO. LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved O
RW Permit Required 0
Street Use Permit Required 0
EXISTING _ PROPOSED _ Inspection Required 0
Sidewalk Required 0
REQUIRED DEDICATION _ FT underground O
— Wrnn r. uued 0
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES[3 NO O z
tY
W
REMARKS w
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROIJDRAINAGE z
ENGINEERING REVIEWED BY DATE
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d% FIRE REVIEWED BY DATE w
z CITY ZIP TELEP ONE
ri V/ i�� z L
TATE LICENSE NUMBER EXPIRATION DATE BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
01 - REQ'D COMPLETED EXEMPT
/V w�6 OYES ONO
CAH ZONE SIGN AREA HEIGHT
-' PROPERTY ACCOU TPAR N
TAX%/'/ % (�' ALLOWED .PROPOSED ALLOWED PROPOSED
(j (r �f STUDY O
7NEW RESIDENTIAL ❑ PLUMBING I MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR
COMMERCIAL COMPLIANCE OR z
❑ ADDITION ❑ CHANGE OF USE z
MIXED USE PARKING LOTAREA PLANNING REVIEWED BY DATE g
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REQ'D PROVIDED
GRADINGFENCE
❑ REPAIR 13CYDS ❑ ( X FT.) REMARKS
EluOTHER
DEMOLISH 1:1 TANK Ffii( julam— pal
z ❑GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ❑ ROCKERY ❑ FIRE ALARM
0
a (TYPE OF USE, BU NESS R ACTIVITY) �jXPLAINi
TYPE OF CONSTRUCTION COD OCCUPANT
� v "1f4✓✓✓777 /,�/' /,iw�/ GROUP
C' NUMBER NUMBER OF �'✓
OF t DWELLING �� SPECIAL INSPECTION CONSULTANT - OCCUPANT
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.STORIES f UNITS LOAD
-� REQUIRED 0 YES
DESCRIBE WORK TO BE DONE
r REMARKS o
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GEOTECH REPORT �
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BY:
STRUCTURAL DESIGN oF
BY: (ice (J V
I '� VALUATION
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Description FEE Description FEE
Plan Check Slate Surcharge
HEAT SOURCE LOT SLOPE% 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 9
j SEPARATE PERMISSION,
Engr. 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 Engr. Inspection
N *APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review --' Plan Chk. Deposit
Lu IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
: EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection —' Receipt #
i 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. Due r
i NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT 1 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 pormit 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 Foes 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 COMPENSAT RANCE AND RCW 18:27.. C OFFICIALS SIGNATURE DAT
SIG TUR OW ER U 6 T): DATE `. GNED --.� (425) ; �, j �
771 =0220 RE ED'BY, DATE
NTIO EXT. 1333 ��/ -' ��
IS UNLAWF L TO USE OR O CUP A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS B MADE AND APPROVAL OR A.CERTI- ORIGINAL -FILE YELLOW - IN PELT R
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 1 IBC1101 IRC1106 PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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