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PERMIT EXPIRES
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CONSTRUCTION PERMIT APPLICATION ADDRESS 9 e�b
OWNER, NAME/NA�E OF BUSINESS
PLAT NAME/SUBDIVISION NO. LOT NO, LID NO
d LID FEE
0: MAILING ADDRESS I
uj PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApproved [3
z RW Pernitil Required E3
0 Street use Permit Required L3
EXISTING PROPOSED inspection Required 0
C TY ZIP TELEPHONE E3
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Sidewalk Required
REQUIRED DEDICATION FT underground 13
As — Wiring required Ell
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
NAME
YES 13 NO13 z
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t= ADDRESS REMARKS z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE E5
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CITY ZIP. TELEPHONE
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NAME �aAO5
ENGINEERING REVIEWED BY DATE
ADDRESS
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701 1 DATE
FIRE REVIEWED BY LU
TELEPHONE 0:
z CITY ZIP M
0
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SEPA z
EXPIRATIUN DATE CHECKED BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION
STATE LICENSE NUMBER REQ'D COMPLETED I EXEMPT 0
10YES ONOI x i
HEIGHT 0
CA# C>e;— 'Y) ZONE SIGN AREA M
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< PROPERTY TAX ACCOUNT PARCEL NO. V'E
0 V WAI ALLOWED PROPOSED ALLOWED PROPOSED
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LOT COVERAGE'S REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
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NEW. —.15LRESIDENTIAL zi�5 > ALLOWED PROPO FRONT SIDE REAR
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COMMERCIAL C-01rPLIANCE OR .2-st -7 S' 15 iJ/A%2: II4/A t41A ZE M
El ADDITION . 0 CHANGE OF USE 1`� cx" le, I C 0
E] MIXED USE PARKING LOTAREA PI."NG REVIEWED BY DATE M 0
REMODEL. MULTIFAMILY SIGN REQ'D PROVIDED1 S/tpj —1 0
FENCE
REPAIR GRADING X FT.) REMARKS
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TANK OTHER M Z
DEMOLISH jo —i
GARAGE FIRE SPRINKLER C
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(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN.
TYPE V��ON CODE OCCUPANT
GROUP
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Cn oz 0
UJI NUMBER NUMBER OF -n
OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
LOAD
0 STORIES UNITS
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DESCRIBE WORK TO BE DONE M M
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Description FEE Description FEE z
State Surcharge
Plan Check 'SO
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HEAT SOURCE LOTSLOPE% VESTED DATE Surcharge
Building Permit City z
'01 0
PLAN CI'111cCK NO: Plumbing Base Fee
Tj__ 4Z, 0
Mechanical M
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
Grading
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
_j SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
uj
11. PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
0 U 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIR I S, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
ui IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
_j Fire Inspect ion Receipt #
2 EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
W INDIRECTLY
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
C' DEEMED TO MO
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee Receipt #
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 receipt is acknowledged in space provided
IN VIOLATION OF THE LABOR CODE OF STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S COMPENSATP_�!UR�NCE D RCW 118:27. OFFICIALS SIGNATURE DATE
URE(OW EROI<4A��ENT)Y.: DATE SIGNED Y.N.
S!n r (425) � k�Lc C-Z)rr�JCL !d
14- 771 m0220 RELEASED BY D)E
ATTENTION EXT. 1333 V3
IT IS UNLAWFUL TO USt-Ok OCCU ILDING OR STRUCTURE UNTIL 16W , I I
1) F11 F - YELLOW INSiECTOR
.A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 if IBC110 / IRC110. PINK -OWNER - GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
6 6
PERMIT
CITY OF EDMONDS NUMBER
DATE RECE