20050437.pdft
0 1 DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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MAILING ADDRESS
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CITY ZIP TELEPHONEZo(, Z_d:� 2,
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NAME
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STATE LICENSE NUMBER
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PROPERTY TAX ACCOUNT PARCEL NO
4191�
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PERMIT EXPIRES 7 lit
PERMIT
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PLAT NAM EiSUB DIVISION NO. LOT NO. LID NO
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL. STREET MAP IESCPApptoled U
RW Prenul R.,11fed 13
Street Use Permit Requited El
EXISTING PROPOSED Inspection Requited 13
Sidewalk Required E3
REQUIRED DEDICATION ___PLTMA=__T"P 13
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OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE z
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FIRE REVIEWED BY DATE III
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PLANNING REVIEWED BY DATE
REO'D . PROVIDED
REMARI�S
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ION OCCUPANT
GROUP
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OF ELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
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FIRE SPRINKLER
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REAR
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REQUIRED 13YES
DESCRIBE WORK TO BE DONE
REMARKS
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GEOTECH REPORT
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STRUCTURAL DESIGN
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VALUATION
$
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE LOTSLOPE% VESTED DATE
PLAN CHECK NO:
Building Permit
Plumbing
City Surcharge
Base Fee
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0,
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Grading
Engr. Review
rl
X PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
Al
PERMIT LIMIT: SEE ECDC i9.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
A APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
A
Fire Review
Plan Chk. Deposit
oe
;N INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMOND3, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
LandscapeInsp.
Total Amt. Due
I
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
CE
M DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINAN
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0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.0
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Recording Fee
Receipt #
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APPLICATION APPROVAL
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
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/tier Deputy: and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
1AfA0U11J1T_7MkJ OCI ATING TO
Cr%o 1KI4Z0II=PTIr%KI
receipt is acknowledged in space provided
IN VIOL ION OF THE LABOR CODE OF Iniz olmilz Or
. WORKMEN'S COMPENSAT INSURANCE AND RCW 18:27. FFI IALS SIGNDRE DAT
(425)RE (OWNER DFATS NED
.0220
S7 771 RELEA( By
4TTtNTION 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! IRC110. PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKIRG 4 COPIES
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