20050422.pdfDATE RECEIVED
PERMIT EXPIRES (•
CITY OF EDMONDS Nu BERCb0 q
CONSTRUCTION PERMIT APPLICATION JOB SUITEIAPTN
ADDRESS I l . 1 1 ^�
OWNER NAME/NAME OF BUSINESS t//]!//1 vr/ 1 K
CA E PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
MAILING ADDRESS LID FEE $
CLA /{ •I PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPAppro.ed O
lY RW Permit Required
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street Use Perms Required E3
CITY ZIP TELEPHONE EXISTING PRQPOySED Inspection Required O
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NAME METER SIZE LINE SIZE. NO. OF FIXTURES PRV REQUIRED
I=1RE ARSHAL YES O. ^40E
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ADDRESS REMARKS `r z
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O STATE LICENSE NUMBER EXPIRATION DATE E E BY VARIANCE OR CU SHORELINE OR ADEN INSPECTION SEPA m
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CA#% ZONE SIGN AREA HEIGHT _
a PROPERTY TAX ACCOUNT PARCEffLILLI,N0. _� i 1 p,� ALLOWED PROPOSED ALLOWED PROPoseD
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LOT C REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) LTi
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❑ NEW ❑ PLUMBING / MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR Q
❑ COMMERCIAL COMPLIANCE OR
❑
ADDITION MIXED USE ❑ CHANGE OF USE. z Q C
1:1 MIXED LOTAREA PANNING REVIEWED BY DATE g
❑ REMODEL ❑ MULTIFAMILY El SIGN REQ'D PROVIDED = m
FENCE m Z
GRADING CYDS _
❑ REPAIR ❑ ❑ ( X FT.) REMARKS � p =A'
OTHER D Z
❑ DEMOLISH TANK ❑ r- _
_ ❑ CARPORT GARAGE ❑ ROCKERY NING WALL ❑ FIREA ARM FIRE LER
a (TYPE OF USE, BUSINESS OR AC IVITY) AIN: O mn
TYPED Ot{$TRU T N QO,DE7 OCCUPANT
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Lu NUMBER NUMBER OF _ M
OF DWELLING SPECIAL INSPEC ION CONSULTANT OCCUPANT rri m
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STORIES UNITS LOAD 0 0)-� D YES
DESCRIBE WORK TO BE DON REQUIRED 0 i
REMARKS z C M
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BY: Z r
STRUCTURAL DESIGN'.
BY:
VALUATION _
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Description FEE Description FEE 2
Plan Check Slate Surcharge O
HEAT AMURCF LOT SLOPE%. VESTED DATE
Building Permit City Surcharge -i
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PLAN CK NO: Plumbing Base Fee M
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO MBChanIC81 .
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC Gradin
ONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g
SEPARATE PERMISSION,
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
oW PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection
W•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
N EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
_ ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY r
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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
= NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee Receipt # 2P ho I
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 hisihor Deputy: and Fees aro 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 in space provided
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
OFFI SSI UR' DATE
SIGNAT E ( NER O E )
F
IGNED (425)
0� 771-0220 RELEASE B DATE
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 I IBC110 1 IRC1104 PINK • OWNER GOLD • ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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