20050395.pdfDATE RECEIVED _
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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CITY ZIP TELEPHONE
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NAME
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PERMIT 007f�S"^
NUMBER V' �� S
JOB SU .IAPT#
ADDRESS 1
PLAT NAME/SUBDIVISION NO, OT A. LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApproved O
RW Permit Required 17
Street Use Permit Required E3
EXISTING __PROPOSED Inspection Required 0
Sidewalk Required E3
REQUIRED DEDICATION FT Underground 0
Wilinq required 0
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
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YES E3 NOE3 Z
REMARKS -FLIKSUANT TO UPCzW
OW ERICONTR T S (520RAINAGE
SHALL BE INSTALLED ON THE W
NAME CBL#
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ENGINEERING REVIEWED BY DATE
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In addition to the required
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY VARIA �p p ED
. - listed p>anSio�i t8itlk �0*q0 COIAPL ED EXEAIPT
j PROPERTY AX T PARCEL N
CA edEa l �t ilii n • FI IGHT
WAIVER ALLOWED PROPOSED ALLOWE PROPOSED
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❑ NEW RESIDENTIALUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
!dALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR t7
❑ COMMERCIAL COMPLIANCE OR z
❑ ADDITION ❑ CHANGE OF USE Z I
❑ MIXED USE PARKING LAN'T"TO)
OTAREA PLANNING REVIEWED BY DATE g
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REQ'D PROVIDED " 608
❑ REPAIR ❑ GRADING ❑ FENCE Uia16
CYDS ( X FT.) REtvj(1�rz• A L?
❑ DEMOLISH ❑ TANK 1:1
OTHER PwA II.M,
_ ❑GARAGE RETAINING WALL FIRE SPRINKLER��AT
CARPORT ❑ ROCKERY ❑ FIREALARM
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(TYPE OF USEi
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� 1�1(JIVj`�� TYP ONSTRU TION COD 3 OCCUPA
I ti GROUP
oNUMBER NUMBER OF
OF DWELLING '. SPECIAL INSPECTION CONSULTANT OCCUPANT
O STORIES UNITS LOAD
0 REQUIRED 13YES
DESCRIBE WORK TO BE bONE
REMARKS i
0
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GEOTECH REPORT rp
BY:
[C4 Lro STRUCTURAL DESIGN
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VALUATION
Description TFEETDescription FEE
Plan Check SurchargeHEAT SOURCE LOT SLOPE% VESTED DATE
Building Permit urcharge
PLAN CHECK NO: Plumbing Base Fee
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 Gradin
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g
t SEPARATE PERMISSION,
Engr. Review
W PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
a PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
a '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 #
Q 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
i NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Pr Leon
Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I 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 R pernnt Until signed by the
THE OWNER. I AGRq TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• CALL
TION; AND IN DOING WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED ling Official or his/her Daputy and Foes aro paid, and
IN VIOLATION OF THE BOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION rduupl is acknowledged n space provided
OMP.ENSAT N INSURANCE AND RCW 18:27.
OF)YCI S 5 , ATUI
SIGV�RE LO(W[/NER O L�: /jL• r J DATE �SI.GNED << . (425) �`Y
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05 ler y71'022
F2i.LFASF )t 'D*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 • FIF[ YELLOW INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC1091 IBC110 I IRC110. PINK .OWNER • GOLD • ASsesSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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