20050418.pdf.may
DATE RECEIVED C
CITY OF EDMONDS
[NAIAE
STRUCTION PERMIT APPLICATION
EINAME OF BUSINESS
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!� S PERMIT EXPIRES
NUMBER i�0os _0 4
JOB ! / SUITE/APT#
ADDRESS 11
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PLAT NAM EiSUBDIVISION NO. LOT NO. LID NO.
LID FEE 5
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved
RW Permit Required
Street Use Perms Requited
EXISTING PROPOSED Inspection Required
Sidewalk Required
REQUIRED DEDICATION FT Underground
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METER lType RItb flZj. �' Ili Ni�l�lil`Tu�u1 reQl�rCil IR D
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IX ADDRESS OBSERVER BY CITY INS �'U
FIRE REVIEWED BY DATE it
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LICENSNUMBER EXPIRATI N D E/ CHECKED B VARIANCE OR CU SHORELINE OR ADB# INSPECTION ED I E
n� W I� YESQ O NO COMPLETED EXEMPT
-J P PROPERTY
X �J l5/ •V 1(j CAI$ ZONE SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PAR EL.
W 3 L� �\ 3 .\ /I WAIVER O ALLowED PROPOSED ALLOWED PROPOSED
(, U CJu STUDY 0
❑ NEW ® RESIDENTIAL ❑ PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLO RA . ERQU , Sh ,R AR FRONT^ L/R SIDE REAR m
❑ COMMERCIAL COMPLIANCE OR ~�~14 z
❑ ADDITION ❑ MIXED USE ❑ CHANGE OF USE r Z
REMODEL A �IC�1� L TARE A PIy,A�NNI�G REVIEWED BY ATE g
® ❑ MULTIFAMILY ❑ SIGN REQ' ROI�I�D .et°7or !ll[llc�ustrieS o
❑ REPAIR ❑ GRADING CYDS ❑ FENCE X FT.) REMARKS
❑ DEMOLISH 1:1TANK (� OTH R
y ElGARAGE RETAFIRE SPRIA
CARPORT 1:1RO KIERY NING WALL FIRE ALARM LER
(TYPE OF USE, BUSINESS OR ACTIVITY EXPLAIN:
IL `t, TYPE OFMSTR CO OCCUPANT
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NUMBER NUMBER OF
NT
OF 11 DWELLING 1 SPECIAL INSPECTION CONSULTANT OCCUPA
a STORIES T c � UNITS 1 LOAD
REQUIRED O YES
DESCRIBE WORK TO BE DONE
REMARKS _
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GEOTECH REPORT �
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VALUATION
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE
Building Permit City Surcharge
PLAN CHECK NO: Plumbing Base Fee . O
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO McChanIC2I
BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBIC Cdfadl
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION. Engr; Review
w PERMIT APPLICATION: SEE ECDC 19.00,005(A)(5)
a PERMIT LIMIT: SEE ECDC19.00,005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection
in Fire Review Plan Chk. Deposit
w •APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS p
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 #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE `%�/,l
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF.ANY CITY ORDINANCE Landscape Insp. Total Amt. Due ( w
= NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION -0 r
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 hlslhor Deputy: and Fees are paid, and
TION; AND IN DOING THE WORK AUTHQRIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR O E OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged In Spate pro ided
WORKMEN'S COMP NSATION I SU N E AND RCW 18:27, FI GNU E DATE
SIGNATURE (DWLJZ). DATE SIGNED ` (425) w
5 � Z, 0 / 771 -0220 LEA D BY DAT
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 l IBC110 / IRC110, PINK -OWNER GOLD -ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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