20050519.pdfDATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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WILING ADDRESS
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CITY ZIP TELEPHONE
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NAME
PURI
NAME CBL#
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ADDRESS 0 ci
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CITY ZIP TELEPHONE
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STATE LICENSE NUMBER EXF
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PROPERTY TAX ACCOUNT PARCEL NO.
00 �20f —3--400
00 /9 45:po
El NEW
��RESIDENTIAL
ADDITION
COMMERCIAL
MIXED USE
REMODEL
MULTIFAMILY
E3 REPAIR
GRADING . CYDS
DEMOLISH
TANK
GARAGE
o RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN
NUMBER NUMBER OF
OF OWEI.
STORIES 'V I UNITS
DESCRIBE WOF�K TO BE DONE
liu
KPLUMBING / MECH
, COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( X FT.)
OTHER
FIRE SPRINKLER
FIREALARM
00'
HEAT SOURCLF' LOTSLOPE% VESTED DATE
PLAN
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
&APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
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
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
PERMIT EXPIRES
PERMIT
NUMBER 66 / q
JOB SUITE/APTO
ADDRESS Z_ lie
2-776 7
NO. LID NO.
PLAT NAMEISUBDIVISION No. �7 LID FEE $
PUBLIC RIGHT OF WAYPER OFFICIAL STREET MAP TESCPApproved E3
RW Petril Required 13
Street Use Permit Required 0
EXISTING PPSED I' I R "Ifed 13
13
P I U a ound 0
R E 0 U I R E D D E Do 11 C AT 110 N1 Ff
r,. . �"Wrv__n t r~ftvv E3
METER SIZE V1iNA0HAX`r11J*A LU �WQFOUIRED
OYTS 13 NO CI z_
AFFIDA ITS SHALL 0:
LU
REMARKS Lu
OWNER/CONTRACTOR RESPONS113103 E=EIRIE41-1DRAINAGE z
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ENGINEERING REVIEWED BY
FIRE REVIEWED BY
VARIANCE OR CU
CA#
WAIVER
STUDY
PARKING
REO'D . PROVIDED
REMARKS
DATE
JTPC 608
SRAI,LREDISTAM�EDNEAP- LU
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SHORELINEORADBM I INSPECTION SEPA
REO'D COMPLETED I EXEIAPT
13YES 13NOI
or .1,
fiWo V&&FT.)
R
LOT AREA I PLANNING REVIEWED BY
OCCUPANT
GROUP
0
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SPECIAL INSPECTIO11' CONSULTANT OCCUPANT
REQUIRED 13, LOAD
REMARKS
In the required-
GEOTECH 4EPORT
BY: pressuretrelief valve, an approved
STRUCTUI liffiCd
BY: expansion tank shall be
VALuATIqNstalled bn all hot water tanks,
$ [UPC
FEE Description
State Surcharge
City Surcharge
0 Base Fee
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due (0
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPkOVAI
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 hisitier Deputy: and Fees ate paid. and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED receipt is acknowledged in space provided.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S COMPENSAT40111114SURANCE AND RCW 18:27. 1 0 LSNGNAIURE I DATE
E - R (OWNER ;IiGI�Njl DATE SIGNED (425)
.
771-0220 EL S
�ktTLNTION EXT. 1333
ITISUNLAWFULTOUSEOROCCUPYA BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 I IRC110.
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapeinsp.
Recording Fee
ORIGINAL -FILE YELLOW -INSPECTOR
PINK -OWNER GOLD - ASSESSOR
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