20050458.pdfi
I
DATE RECEIVED �• i /�
[PERMIT EXPIRES
CITY OF EDMONDS NUMBER IT
CONSTRUCTION PERMIT APPLICATION JADDRESs / SUIT APTtt
OWNER NAME/NAME OF BUSINESS
/Z r, �L2 (FL PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
MAILING ADDRESS LID FEE 5
ate, J PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Promil oqui ❑
T RW CPAP Roved ❑
Sneer Use Parmd Required ❑
CITY ZIP TELEPHONE EXISTING PROPOSED Inspocoon Requeod ❑
Sidewalk Required O
72 r REQUIRED DEDICATION FT Underground ❑
`O Winn caC3re red
NAME METER SIZE 7]7E . NO. OF FIXTURES PRV REQUIRED
YES O NOD =
W
ADDRESS REMARKS W
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE z
O
z
w
CITY ZIP TELEPHONE
CBL#
ENGINEERING REVIEWED BY DATE
ADDRESS
FIRE REVIEWED BY DATE W
CITY ZIP. TELEPHONE
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY vAFtrANCE OR CU SHORELINE OR ADBI{ INSPECTION SEPA
REQ'D COMPLETED I EXEMPT
YES D NO
or
FACS [ V �! /'
PROPERTY TAX ACCOUNT PARCEL NO. CA _ ZONE SIGN AREA HEIGHT
D O Q WAIVER O N' ALLOWED PROPOSED ALLOWED PROPOSED
on A 12 Ll STUDY r✓ `
NEW ❑ RESIDENTIAL ❑ PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
COMMERCIALCOMPLIANCE OR `��
❑ ADDITION ❑ CHANGE OF USE z
❑ MIXED USE PARKING LOTAREA PL NING REVIEWED BY DATED"�J g
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REO'D PROVIDED✓/Q _
FENCE
❑ REPAIR El GRADING CYOS ❑ ( X FT.) REMARKS
❑ DEMOLISH ❑ TANK ❑ OTHER
GARAGE ❑ CARPORT ❑ RETAINING ROCKERY WALL FIRE ❑ FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
�C �. / TYPE CONS UCTION COD OCCUPANT ' t
Irmo I wwf&11�11 #s O.� GROUP
NUMBER TNUMBEROFOF WELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
STORIES NITS LOAD
REQUIRED O YES
DESCRIBE WORK TO BE DONE
REMARKS _
0
S GEOTECH REPORT m
BY:
STRUCTURAL DESIGN
BY:
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
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
E DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g
SEPARATE PERMISSION,
F Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00,005(A)(5)
L PERMIT LIMIT: SEE ECDC 19.00,005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION MIN
"APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
U IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
E EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
a ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
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 7
= NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.•
Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT 1 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 his/her Deputy: and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED FOR INSPECTION receiptis acknowledg p ed in ace provided
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27. F LS SIGNA RE DATE
SIGNATE (OWNER OR GENT). DATE SIGNED (425) V/ '/ 'w//
SigcSo.0 771=0220 TWEELVAW B ATE
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 CERT[- ORIGINAL -FILE • YELLOW -INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109I IBC1101 IRC110. PINK -OWNER • GOLD - ASSESSOR
10/04 . PRESS HARD = YOU ARE MAKING 4 COPIES 1.
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