20050413.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BVSINESS
MAILINGADDRESS
CITY
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NAME
NAME
ADDRESS
TELEPHONE
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STATE LICENSE NUMBER EXPIRtTION DATE Cl(IEVKEP 2Y
PERMIT EXPIRES
PERMIT
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NUMBER
JOB
ADDRESS
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PLAT. NAME/SUBDIVISION NO.
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LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPAprifoved
0
13
RW Permit Required
Street Use Pernill Required
C1
EXISTING PROPOSED
InspKlion Required
E3
Sidewalk Required
[3
REQUIRED DEDICATION
FT
Unarugiound
Wiring required
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C3
METER SIZE7 LINE SIZE
NO. OF FIXTURES PRV REQUIRED
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YESO NOO
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REMARKS
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OWNERiCONTRACTOR RESPONSIBLE
FOR EROSION CONTROL/DRAINAGE
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ENGINETMWhN%ftb11f'r'____ DATE
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FIRE REVIIE�Wgh* nun uj
VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
7 REO'D ro EXEMPT
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PROPERTY TAX ACCOUNT PARCEL NO. eng r W110"3
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NEW RESIDENTIAL PLUMBING / MECH L OVERAGEj- jf4tff%jaM(FT.)
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COMMERCIAL OMPLIANCE OR
ADDITION
MIXED USE CHANGE OF USE
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PARKING LOT AR aLANNING REVIEWED B
REMODEL 13 MULTIFAMILY SIGN REO'D PROVIDED S.
-PURS AST TO UPC ( )Og
GRADING E:i FENCE 013 VALVE
REPAIR 1:1 CYOS X FT.) REMARKS ApIlESSIUK
OTHER RUAI 3,!ftFj1NSVjJ"WEXP-
DEMOLISH 1:1 TANK E]
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY. FIREALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
6E*43AqKS (FT.)
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iL TYPE,Qf'ePN CODE OCCUPANP7:?
GROUP
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0 STORIES UNITS. LOAD
DESCRIBE WORK TO BE DO&E REQUIRED 13YES
REMARKS
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
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Description FEE Description FEE
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Plan Check State Surcharge
SOURCE LOTSLOPE% VESTED DATE
Building Permit City Surcharge 16-0,
HECK NO: Plumbing 6'<l') 0 0 Base Fee 0
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
2 Engr. Review
11C PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
W
PERMIT LIMIT., SEE ECDC 19.00,005(A)(G) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
in 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
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 #
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
�Q_j DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp- Total Amt. Due
01 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee Receipt #
I HEREBY ALKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPRO) f A
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
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged tit space provided
WORKMEN'S COMPENSAT!�N INSURANCE AND RCW 18:27.
OF E IDAT5
MG E N
SIGN#PTURE (OWN GEN DATE 3IGNED (425)
hilos'j 771-0220 RELEAStDIBY DAA
AfYTNTION F EXT. 1333 . J
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 if IBC110 / IRC110. PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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