20050486.pdfDATE RECEIVED
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CITY OF EDMONDS NUMBERIle 56(
CONSTRUCTION PERMIT APPLICATION ADDRESS SUITE/APT#
OWNER NAME/NAME OF BUSINESS _ 0 P, til
C _ f PLAT NAMEfSUBDIVISION NO. LOT NO, LID NO.
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NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
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NEW UMBING I MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
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❑ ADDITION ❑ CHANGE OF USE _
❑ MIXED USE
' PARKING LOT AREA PLANNING REVIEWED BY DATE g
❑ .REMODEL ❑ MULTIFAMILY 1:1 SIGN REQ'D PROVIDED
❑ REPAIR El GRADING CYDS ❑ FENCE X FT.) REMARKS
❑ DEMOLISH ❑ TANK 1:1OTHER
GARAGE z ❑ CARPORT ❑ ROCKERY IG WALL 1:1 FIRE ALARM FIRE LER
CL (TYPE OF USE, BUSIyESS ORS ACJIVITY) EXPLAIN:
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NUMBER NUMBER OF l/�
OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
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Description FEE Description FEE
Plan Check State Surcharge
HEWHE RCE OT SLO % VESTED DATE • i--+
Building Permit City Surcharge
PLAN ColltCK NO: Plumbing Base Fee tV
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO MCChanICBI
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC Gradin
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g
t SEPARATE PERMISSION.
2 Engr. Review
w PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
a PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
in '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
ED NDS, 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 Amt. Due
= 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 his/her Deputy: and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY; NO PERSON WILL BE EMPLOYED OR INSPECTION receipt is acknowledged to space provided:
IN VIOLATION OF THE LABOR CODE F THE STATE OF WASHINGTON RELATING T
WORKMEN'S C SURAN E AND RCW 18;27, FFICIALS GNATURE DTE
SIGNATU (OWNERIGENV)/ DATE S7/:j
G ED (425). �`✓� �►
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/ L7 S 771m0220 ELEASED BY DATE
ATTENTIO EXT. 1333,
IT IS UNLAWF TO USE OR OCCUPY A BUILDING OR STRUCTURE U IL
A FINAL INSPE=CTION HAS BEEN MADE AND APPROVAL OR A CER I- ORIGINAL -FILE YELLOW -INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109 / IBC110 I IR 11 PINK -OWNER GOLD • ASSESSOR
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