20050394.pdfDATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF B77NESS
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MAILING ADDRESS
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CITY ZIP TELEPHONE 4J25
NAME
ADDRESS
TELEPHONE
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PU/7,7W 06 -7 #11__ L�l
ADDRESS
CITY ZIP TELEPHONE 2.41;'(1
4::�FIWRE L_RS�? i/Z90
STATE LICENSE NUMBER EXPI ATI DATE NIIECKED BY
PROPERTY TAX ACCOU4 PARCEL NO. y J
PERMIT EXPIRES /OC
PERMIT
NUMBER
JOB SUITE Tf$
ADDRESS 'Aye
PLAT NAMEISUBDIVISION NO. LOT NO LID NO
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApprov'
R%'V Permit Required
Street Usti Permit Requited
EXISTING PROPOSED Inspection Required
Side�alk Required
REQUIRED DEDICATION. FT underground
Wiling required
METER SIZE SE f E8TOffiLLR.Ep PRV REQUIRED
if-941iow.— ST O&ES 13 NOM
REMARKS
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
VARIANCE OR CU SHORELINE ORADEII I INSRFECTION SEPA
_QD COMPLETED I EXEMPT
13YES 13NOI
CA# ZONE SIGN AREA HEIGHT
WAIVER 13 ALLOWED I PROPOSED ALLOWED , PROPOSED
STUDY 13 1 1 1
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z
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tu
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NEW
ESIDENTIAL
PIC
PLUMBING I MECH
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
FRONT URSIDE REAR
0
ADDITION
OMMERCIAL
COMPLIANCE OR
3
z
CHANGE OF USE
z
MIXED USE
. PARKING
LOTAREA
PLANNING REVIEWED BY DATE
5
Im Monwinc!"I
06
MULTIFAMILY
SIGN
REPAIR
GRADING
CYDS
FENCE
( X FT.)
REMARKS
DEMOLISH
TANK
OTHER
GARAGE
CARPORT
RETAINING WALL
ROCKERY
FIRE SPRINKLER
FIREALARM
(TYPE OF USE, BUSINESkOR
ACTIVITY) E2(PLAIN:
TYF`Efi�ION
C�E�
OCCUPANT
GROUP
NUMBER
NUMBER OF
OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
STORIES UNITS I I LOAD
ZIP
DESCRIBVO;��T? BE Dofw. I
C_ 017z:s
REQUIRED TEO
REMARKS
GEOTECH REPORT
BY:
BIPJAIds 70 if:-1tPeP1*4CC 14
STRUCTURAL DESIGN
1:5 T:
L9 xxo-) $404 INP
VALUATION
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Description
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Plan Check
LOTSLOPE%
VESTED DATE
Building Permit
PLAN CHECK NO:.
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBIC
2- DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Grading
Engr. Review
cc
11.
2—
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
W
PERMIT LIMIT. SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
in
0 OAPPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
U.1 IN INTEREST, AGREES TO INDEMNIFY DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Do' ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEM ED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.
Fire Review
Fire Inspection
Landscapeinsp.
-
Recording Fee
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
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
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
WORKMEN'S COMPENSATION INSURANCE AIN CW 18:27.
ZYR
SIGN IRE I ER OqAGENT): DATE StGN (425)
771-0220
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* T"Lelto, -
ATTENTION . LA L -1 a.aa
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 I IRC110.
FEE bescription
State Surcharge
City Surcharge
I Base Fee
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
tA_1
0
1 Receipt # ,,-2 1,? S � I
APPLICATION APPROVA 1
This application is not a permit until signed by the
Building Official or his/her Deputy and Foes art- paid, and
rriceipt is acknowledged in space provided
RELEASED BY
110104 PRESS HARD - YOU ARE MAKING 4 COPIES
DATE
ORIGINAL - FILE YELLOW - INSPECTOR
PINK -OWNER GOLD - ASSESSOR
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