20050537.pdf1I I/ 1 DATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER A tPJNAMF OF BUSINESS
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CITY ZIP TELEPHONE
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NAME
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✓ 5 PERMIT EXPIRES /
PERMIT
NUMBER Otof0051
JOB SUITE/APT#
ADDRESS / 0;
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PLAT NAME`SSUBUUBDIVISION NO. LOT NO LID NO.
LID FEE $
PUBLIC RIGHTOF WAY PER OFFICIAL STREET MAP TESCPApproved O
RW Pernw Requred d
Street Use Permit Required C1
EXISTING _ PROPOSED Inspection Required 0
Sidewalk Required 0
REQUIRED DEDICATION _ FT underground
Witing required
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
C7
YES E3 NOD z
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REMARKS W
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE z
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ENGINEERING REVIEWED BY DATE
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K O FIRE REVIEWED BY DATE W
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19d LIM, 11117
STA LICENSE NUMBER X ATION A E BY VARIANCE OR CU SHORELINE ORADB# INSPECTION SEPA
7OYESQOCOMPLETED E%Er.1fT
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PROPERTY TAX ACCOUNT PARCEL NO. CA# ZONE SIGN AREA HEIGHT
WAIVER �L+,� ALLOWED PROPOSED ALLOWED PROPOSED
STUDY D LN'/
NEW ❑ RESIDENTIAL ❑ PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR c7
COMMERCIAL COMPLIANCE OR Z
❑ ADDITION ❑ CHANGE OF USEz
MIXED USE
YJG REMODEL El
LOT AREA PLANNING REVIEWED BY DATE g
MULTIFAMILY ❑ SIGN REO'D PROVIDED
❑ REPAIR ❑ GRADING ❑ FENCE
CYDS ( X FT.) REMARKS
DEMOLISH ❑ TANK ❑ OTHER
RETAININGGARAGE WALL LER
z ❑ CARPORT ❑ ROCKERY ❑ FIREALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
a—a Q 'i �i TYPE OF ONS'rRUCTION CODE OCCUPANT
U rC/C/ r GROUP
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NUMBER NUMBER OF
OF ) DWELLING�—y SPECIAL INSPECTION CONSULTANT OCCUPANT
o STORIES / UNITS `C7 LOAD
-i REQUIRED 13 YES
DESCRIBE WORK TO BE DONE
REMARKS z
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' fYU GEOTECH REPORT
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BY:
STRUCTURAL DESIGN
BY:
? VALUATION '
Description FEE Description FEE
Plan Check U State 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 Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC Gradin
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g
SEPARATE PERMISSION,
Engr. Review
IY PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
W PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection 1(,�
c vi *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
1 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES,.AND AGENTS FROM ANY AND Fire Inspection Receipt #
z 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
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27. FF SI N RE DATE
LSIGNATURE(OWNERO AGE DATE SIGNED (425) `J �� 7 SCJC
G 771 =0220E Y !! ATE
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- RIG AL -FILE Y LLOW - IIJSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 I IRC110. PI K -OWNER OLD -ASSESSOR
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