20050491.pdfDATE RECEIVED
• I I
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINA\\ME--OF``B__USINESS
C�VC�G\jT ZhL
MAILING ADDRESS
CITYZIP TELEPHONE
NAME
J PERMIT EXPIRES J422
PERMIT
NUMBER C2005r6 1?/
JOB (� SUITE/APT#
ADDRESS ezco:.C_
PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved ❑
RW Permit Required ❑
Street Use Permit Required ❑
EXISTING _PROPOSED, Inspection Required ❑
Sidewalk Required ❑
REQUIRED DEDICATION FT Underground ❑
immWum re wrud ❑
METER SIZE •I INE �I}E„ p H LIQ. OF FIXTURES PRV REQUIRED
/�L YES O NO O z
re
REMARKS 1 16,00 1 1 1 Lam,w
OW119MRA`C fpg REgFW ffMjEROrRCEN RAINAGE z
it
�� i�e�� fc�^ W�� ^ •^ L" »l I/ ENGINEERING REVIEWED BY DATE
ADDRESS
CITY TELEPHONE
FIRE REVIEWED BY DATE w
ZIP �
Z70
STATE LICENS N EXPIRATI NDA CHECKED Y VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
f p� REO'D COMPLETED EXEMPT
6T q
l i3 YES 13 NO
PROPERTYJAKA(1 T PAiRQEL Pj 0�o CA"
ZONE SIGN AREA HEIGHT
G/!St5LWAIVE ALLOWED PROPOSED ALLOWED PROPOSED
STUDY O
❑ NEW RESIDENTIAL ❑ PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR
❑ COMMERCIAL m
1:1ADDITION COMPLIANCE OR z
❑ MIXED USE ❑ CHANGE OF USE z
1:1 REMODEL PARKING LOT AREA PLANNING REVIEWED BY DATE g
❑ MULTIFAMILY. ❑ SIGN REO'D PROVIDED a
❑ REPAIR ❑ GRADING CYDS ❑ FENCE X FT.) REMARKS
❑ DEMOLISH TANK ❑ OTHER
❑GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ❑ ROCKERY ❑ FIRE ALARM
(TYPEOF USE, BUSINESS OR ACTIVITY EXPLAIN:
NUMBER NUMBER OF w�
OF DWELLING SPECIAL INSPECTION CONSULTAi
STORIES UNITS
DESCRIBE WORK TO BE DONE REQUIRED D YES
REMARKS
-- GEOTECH REPORT
�- . BY:
STRUCTURAL DESIGN
BY:
VALUATION
Description FEE
Plan Check
HEAT SOURCE LOT SLOPE%q VESTED DATE
Building Permit
PLAN CHECK NO: Plumbing
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC,) WILL REQUIRE Grading
t SEPARATE PERMISSION,
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
;1
Jim 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
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection
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.
= NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.•
Recording Fee
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION; THAT THE INFORMATION
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• CALL Bu
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF'WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S CO P NSATION INSURANCE AND RCW 16:27.
FFI
SIGNATURE W AGENT : DATE IGNED (425)
05� 771 m0220 RELE,
OCCUPANT
LOAD
Description FEE
State Surcharge
City Surcharge �—
Base Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due S
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
ilding Official or his/her Deputy: and Fees are paid, and
receipt is acknowtettged to space provided.
CIXS)3IGI11AXURE tl I DATt
ATTENTION EXT. 1333 V
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, UBC109 / IBC110 if IRC1100 ORIGINAL -FILE YELLOW -INSPECTOR
PINK -OWNER •GOLD •ASSESSOR
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