20050459 (2).pdfto
DATE RECEIVEDj
l PERMIT EXPIRES
CITY OF EDMONDS
PERMIT R A> �`"- Cj,� t
CONSTRUCTION PERMIT APPLICATION ooREss �) a
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OWNER NAME/NAME
OF/BUSINESS
P� a. s � ` ! PLAT' NAMEISUBDIVISION N0. LOT NO. LID NO.
MAILING ADDRESS 1 G, 1�+ LID FEE S
0 a > t rV C� S (� 2 (' L�' PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved O
RW Permit Required n
Street Use Permit Required E3
CITY ZIP TELEPHONE EXISTING PROPOSED Inspection Requited O
q1_z '? — Sidewalk Requited O
t �`1 l a J s f0 i!J C1 'J REQUIRED DEDICATION _ _ FT wrunr9rouu� ed O
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES13 NO O Z
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ADDRESS REMARKS w
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE z
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NAME
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ADDRE S
Z CITY
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STATE LICENSE N
6C�� _ �
❑ NEW
❑ ADDITION
E] REMODEL
❑ REPAIR
DEMOLISH
❑GARAGE
CARPORT
ZIP TELEPHONE.
IN
S /LQ A4 r 4 N 49 r4l I✓ ENGINEERING REVIEWED BY DATE
OF
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FIRE REVIEWED BY DATE it
ZIP TELEPH NE
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UMBER E PIRATION DATE CH ED BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
REO'D COMPLETED EXEMPT
,J"'�%�/ OYES ONO
/:OOU/NT PARCEL NO. ✓✓✓ z WAIVER O ZONE SIGN AREA HEIGHT
/ , ALLOWED PROPOSED ALLOWED PROPOSED'
C/)r STUDY O
❑RESIDENTIAL ❑ PLUMBING 1 MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR L7
COMMERCIAL COMPLIANCE OR z
E3 MIXED USE ❑ CHANGE OF USE _
PARKING LOT AREA PLANNING REVIEWED BY DATE g
❑ MULTIFAMILY ❑ SIGN REQ'D PROVIDED
❑ GRADING❑ FENCE
CYDS ( X FT.) REMARKS
❑ TANK ❑ OTHER
❑RETAINING WALL FIRE SPRINKLER
ROCKERY ❑ FIREALARM
•... JSINESSORACTIVITY)EXPLAIN:
TYPE O CONSTRUCTION CODE ' OCCUPANT
GROUP
GNUMBER NUMBER OF lJ J
OF i DWELLING ^ ` r SPECIAL INSPECTION CONSULTANT OCCUPANT
STORIES 1 UNITS IV / - LOAD
p
0 REQUIRED 0 YES
DESCRIBE WORK TO BE DONE
REMARKS
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r l ' GEOTECH REPORT m
BY:
STRUCTURAL DESIGN
BY.
VALUATION
Description FEE Description FEE
Plan Check Slate Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE �--
Building Permit j City Surcharge hj
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 Gradin
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g
SEPARATE PERMISSION, Engr, RCVIEtW
Lu PERMIT APPLICATION: SEE ECDC 19.00,005(A)(5)
a PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection
'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
:E 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 -^
DEEMED TO MODIFY,.WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape InSp. Total Aml. Dile
= NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee Receipt# / i" 54
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 hislhor Deputy: and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED FOR INSPECTION receipt is acknowledged in space provided
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO i
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27. F ALS SI 1 1 D TE
G
6ATESIGNATURE (OWNER OR T): DATESIGNED S (425)
o h /
771 0220 REE ED B
ATTENTION EXT. 1333
IT IS UNLAWFUL TO USEUR 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, UBC1091 IBC110If IRC1106 PINK -OWNER • GOLD - ASSESSOR
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