20050490.pdf� GATE RECEIVED JO
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PERMIT EXPIRES
PERMIT ^_ „
CITY ®F EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION 1OB04
TEIAPT#
ADDRESS-
OWNER EINAME OF BUSINESS /000
PLAT NAME/SUBDIVISION NO.LOT NO. LID NO.
w MAILING ADDRESS LID FEE $
( /� PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved O
O RW Permit Required O
Street Use Permit Required C1
CIN / ZIP TELEPHONE EXISTING _ PROPOSED- __ Sidewalk
Requited O
Underground
Required 0
i REQUIRED DEDICATION, FT Underground O
. f 7 Winno mQuired
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
v YES O NO O Z
�u U)
t ADDRESS REMARKS W
UOWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY ZIP TELEPHONE
rIHE MTRSHAL W
NAMECBL# ` OM CAP
.i 7
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wV V ENGINEERING REVIEWED BY DATE
G ADDRESS '
{ FIRE REVIEWED BY DATE
Z C / Z TELEPHONE ¢
J_�v
00 000 4LO
STAT ENSE NUMBE EXPIRATION DATE BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
RF.O'D COMPLETED I EXEMPT
12
O YES ONO
J PROPERTY TAXACCOUNTP F,Lt�I .i CrYb
CA# ZONE .SIGN AREA HEIGHT
W (/J)o v
WAIVER13 ALLOWED PROPOSED ALLOWED PROPOSED
J vIVL`V'►(j STUDY O
❑ NEWESIDENTIAL ❑ PLUMBING 1 MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR t7
COMMERCIAL COMPLIANCE OR i
❑ ADDITION❑ MIXED USE ❑ CHANGE OF USE i
PARKING LOTAREA PLANNING REVIEWED BY DATE 5
REMODEL ❑ MULTIFAMILY ❑ SIGN REO'D PROVIDED a
❑ REPAIR ❑ GRADINGE]FENCE
CYDS ( X FT.) REMARKS
❑ DEMOLISH ///^^^ TANK ❑ OTHER
_ ❑ CARPORT GARAGE ❑ RETARO KIERY WALL ❑ FIREA ARM NING FIRE LER
(TYPE OF USE, BSINESS OR ACT VITY) XPI`AIN: NST
FE TYP UN COD OCCUPANT
U GROUP
cNUMBER NUM ER OF ER
OF DWELLING I SPECIAL INSPECTION CONSULTANT OCCU NT
o
STORIES UNITS LOAD
REQUIRED YES
DESCRIBE WORK TOB DONE
REMARKS z
jJ_
GEOTECH REPORT
m
BY:
STRUCTURAL DESIGN
BY:
VALUATION
r $
Description FEE Description FEE
Plan Check Stale 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 M@ChanICBI
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
t SEPARATE PERMISSION.
s 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
'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
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 Amt. DueLook— J
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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application Is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or hislher Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTIO receipt is acknowledg d in space provided.
WORKMEN'S COMPENSATI URANCE ANR RCW 18:27.
[�REO
n>ALS�GNPRE ATESIGNA R AGE DATE SIGNE (425)1 I .05
771 =0220B DATE
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 CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1091 IBC1101 IRC110. ORIGINAL -FILE YELLOW -INSPECTOR
PINK -OWNER GOLD •ASSESSOR
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