20050485.pdfDATE RECEIVED -7
PERMIT EXPIRES �G �I
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CITY OF EDMONDS NUM ER
C NSTRUCTION PERMIT APPLICATION JOB SUITEIAPT#
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OWN NAMEINAME/OF BUSINNcln
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i4o� I S PLAT NAMEISUBDIVISION NO. LOT NO.LID NO
cc (LING ADDRESS / 2, LID FEE $
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Streal Use Permd Requited 0 _
F� ZIP LEPHONE EXISTING PROPOSED, Inspection Required I7
_ ..._ Sidewalk Requited 0
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NAME METER SIZE LINE SIZE 70. OF FIXTURES PRV REQUIRED
YES D NOD t7
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L) OWNERiCONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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CITY ZIP TELEPHONE FIRE REVIEWED BY DATE W
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STATE LICENSE NUMBER E PIR TION AT CHECKED BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA.
REQ'D COMPLETED I EXEMPT i
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DYES NO
PROPERTY TAX ACCOUNT PARCEL NO. CAN �_� - ZONE SIGN AREA HEIGHT
W ' ' /� WAIVER D ..�� - ALLOWED PROPOSED . ALLOWED PROPOSED
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❑ NEW RESIDENTIAL ❑ PLUMBING / MECH LOT CO REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) .
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR O
COMMERCIAL COMPLIANCE OR
ADDITION' ❑ CHANGE OF USE z
❑ MIXED USE PARKING LOT AREA PL NIN EVIEWED BY DATE 5
❑ REMODEL❑ MULTIFAMILY ❑ SIGN REQ'D PROVIDED I?�/
GRADING FENCE
❑ REPAIR ❑ CYDS ❑ ( X FT.) RE R
❑ DEMOLISH ❑ TANK ❑
OTHER
GARAGE ETAINING WALL FIRE SPRINKLER
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CARPORT ❑ FIREALARM top
I a ( E OF USE, BUSINESS OR TIVITY) EXPLAIN:
jTiliiI4 OF CONSTRUCTI N 6!31GROUP NT
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O OF DWELLING O, SPE IAL INSPECTION CONSULTANT OCCUPANT
O STORIES UNITS LOAD
o REQUIRED 13 YES
DESCRIBE WORK TO BE DONE
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Description FEE Description FEE
Plan Check � State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE L
Building Permit/ City Surcharge
PLAN CHECK NO: r �� J Plumbing Base Fee
u ! Mechanical % r^
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC Grading
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC,) WILL REQUIRE g
SEPARATE PERMISSION, Engr. Review
w 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 Engf. Inspection
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit ®r�
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF n
f EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt # 7
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY i
= 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
s NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
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 Foes 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
W MEN'S COMPENSATION INSURANCE AND RCW 18:27. C OFFI LS SIGNATUffl DATE
S TUR WNER OR AGENT)_ DATE SI NED (425)a Cj
771'0220 R- SED BY DA E
ATTENTI EXT. 1333 � ) ;';
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE .UNTIL 44
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGI L - ILE • YELLOW -INSP CT
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1091 IBC110 I IRC110' PINK O NER GOLD -ASSESSOR
10104. PRESS HARD - YOU ARE MAKING 4 COPIES
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