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20050531.pdfDATE CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWN NA E/NAME O BUSINE �S� I �� IVI T '/q (...IAUI►Y�tILVII. MAILING ADDRESI✓ � j NAME • ZIP TELEPHONE 6vl TELEPHONE [PERMITEXPIRES PERMIT j_.NUMBER &*� _ G-�✓ ADDRESS %� JOB SUITEIAPT# PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved RW Permit Required Street Use Permd Required EXISTING ___ PROPOSED _ inspection Required Sidowalk Required REQUIRED DEDICATION // FT Underground ---- Wirinq required METER SIZE LINE SIZENO. OF FIXTURES PRV REQUIRED /� YES 0 NO O REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE Nf �',� % CBL# ENGINEERING REVIEWED BY � 1EI I �� I _ CIT TPI cnuna� FIRE REVIEWED BY DATE W Q ¢ r. 71 Iv u STATE LICENSE MBFR EXPIRAT NPATE CHECKED BY ' VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEP. L3 YESOJd,yO COMPLETED EXE T PROPE TY TAX ACCOUNT PARCEL NO. GC v CA# ZONE SIGN AREA HEIGHT 'I WAIVER 13 / y ALLOWED PROPOSED ALLOWED PROPOSED STUDY 13��/ ❑ NEW ❑ RESIDENTIAL1:1PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR COMMERCIAL COMPLIANCE OR ��_. i ❑ ADDITION ❑ CHANGE OF USE i MIXED USE ❑ REMODEL ❑ PARKING LOT AREA PLANNINGREVIEWED BY DATE OV MULTIFAMILY 13SIGN REO'D PRIDED �_ M�l�(.l vT— �! !i(•V REPAIR ❑ GRADING CYDS FENCE ❑ ( X FT.) REMARKS ❑ DEMOLISH ❑ TANK ❑ OTHER ❑ CARPORT GE ❑ ROCKERY RETAINING WALL FIRE ❑ FIRE ALARM LER [ y1 jARK NS RUCTION COIjC� GROUP NT / u NUMBER NUMBER OF 7 0U OF DWELLING STORIES NSPECTION CONSULTANT OCCUPANT UNITS © LOAD DESCRIBE WORK TO BE DONE . 0. YES _ REPORT m RAL DESIGN � � ION ption FEE Description FEE Plan Check State Surcharge : HEAT SOURCE LOT SLOPE% VESTED DATE Building Permit ✓ City Surcharge PLAN CHECK NO: Plumbing Base Fee l 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. a Engr. Review W PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5) a PERMIT LIMIT: SEE ECDC 19.00,005(A)(6) Erlgf. 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 ul 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 OF THIS PERMIT, ISSUANCE OF THISSHALL OT BE DEEMED OISSUANCE MO FY, WAVE OR REDUCE ANY REQUIREMENT F ANYI 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' API ROVA GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF he THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• This application Is not a permit until signed p id. TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or acknowledged edgediDeputy: aria Foes are paid. and IN VIOL ON OF THE LABOR CODE OF E S TE OF.WASHINGTON RELATING TO FOR INSPECTION receipt is ackriowledged n space provided. WORK 'S COM ENSAT INSURANN 18:27. OFFI ATU D TE DATE SNED � SI URE O GENT () 771 =0220 RELEASED BY DATE ATTENTION EXT. 1333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 7 A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109 I IBC110 I IRC110. o PINK - •FILE •YELLOW -INS CTOR PINK •OWNER •GOLD -ASSESSOR 10104 PRESS HARD = YOU ARE MAKING 4 COPIES O M C MO 0 On C =M mz. ,fl DZ r_ -I Cn mn mm N r n m. CN r 'Z'i r D Z 2 Z O M