20050403 (2).pdfr DATE RECEIVED �.r f —'
PERMIT EXPIRES
RMIT
CITY OF EDMONDS NUMBER CxJS `-U
CONSTRUCTION PERMIT APPLICATION los SUITE/APT"
ADDRESS /� r
OWNER NAME/NAME OF BUSINESSF—
PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
MAILING ADDRESS / /� p J LID FEE $
v/ T / I/ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TE5CP App ovod O
RW Permit Required
Stroot Use Pernul Requued Q
CITY ZIP TELEPHONE EXISTING PROPOSED inspection Regwrod O
Sidewalk airdRequited
REQUIRED DEDICATION FT underground O
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NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES O NO 13 z
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ADDRESS REMARKS w
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE z
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TELEPHONE
NAME _ /� ^, C/Bf JL4
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FIRE REVIEWED BY
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STATE LICENSE NUMBER EXPIRATIO7IK3�
TE D BY VARIANCE OR Cu SHORELINE, OR ADBN INSPECTION SEPA
/PI OREQ'D COMPLETED EXEMPT
C61CI G aI� V lv OYES ONOA-
CAN ZONE SIGN AREA HEIGHT
PROPERTY 000 3,D q NO.� .� t�.WAIVER ALLOWED PROPOSED ALLOWED PROPOSED
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E] NEW RESIDENTIAL ❑ PLUMBING / t 1ECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR 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
❑
GRADING FENCE REPAIR ❑ CYOS ❑ ( X FT.) REMARKS
13DEMOLISH Mft�TANK ❑ OTHER
RETAININGGARAGE WALL LER
z ❑ CARPORT ❑ ROCKERY ❑ FIREALARM
a (TYPE 0 PSE, BUSINESSR AC ITY) EXPLAIN: CC
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oNUMBER NUMBER OF
OF. DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
0 STORIES UNITS _ - LOAD
REQUIRE[) 13YES
DESCRIBE WORK TO BE DONE
REMARKS z
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GEOTECH REPORT m
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:�, r ��F vtni1 Description FEE Description FEE
fit, -=-CA % h1volallelop�Q Plan Check State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE Cf�A
Building Permit City Surcharge /50
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 Grading
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g
SEPARATE PERMISSION.
Engr. Review
W PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
a PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engf. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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"APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
w IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection '� Receipt N
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
G DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Arnt. Duo
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Foo 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 apphcal,on rs nol it parnul Until rupwd by tiro
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• CALL Budding Ot6ual or hislhor Deputy and Fous aro pmd and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED FOR INSPECTION cormpl is dcknuwludgod ,n speed provided
IN VIOLATION OF THE LA CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INS RANCE AND RCW 16:27, OF LS SIGI UFIF r DATE
SIGNATURE (OER AGENT): �' oa (425)
lis _
771m0220-IiELFASE l DnIE.
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, UBC109 1 IBC110 I IRC1104 PINK • OWNER • GOLD • ASSESSOR
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