20050546.pdf(A DATE RECEIVED
PERMITEXPIRLS IA, LL
PERMIT
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB IAP
ADDRESS I
OWNER NAMEINAME OF BUSINE .017 a
PLAT NMEL/SUBDIVISION NO. LOT70. LID NO.
MAILINGADDRESS
UJI LID FEE $
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PUBLIC RIGHT OF WAY PER OFFICIAL STRE TESCPApprovea
RW Permit R U E3
CITY ZIP TELEPHONE EXISTING PROPOSED Street Use PlaillfoRdequired 13
Inspection Requited C3
Sidewalk Required 13
2- REQUIRED DEDICATION — FT Undergiound 13
NAME Witing roquifed E3
METER SIZE LINE SIZE OF FIXTURES PRV REQUIRED
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MIXED USE CHANGE OF USE
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ALLOWED PROPOSED
REQUIRED S1
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REO'D PROVIDED
LOTAREA
PL/
MULTIFAMILY SIGN
GRADING FENCE
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REMARKS
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NUMBER OF
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nCRIBE WORK �Q BE DONE
REMARKS
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
$ '*3
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE
LOTSLOPE%
VESTED DATE
Building Permit
City Surcharge
1
PLAN CHECK NO:
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Plumbing
Base Fee
mechanical
THIS PERMIT AUTHORIZES ONLY T ' HE 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
Grading
SEPARATE PERMISSION.
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
Engr. Review
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
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
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Total Amt, Due
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NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION..
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Recording Fee I
Receipt #
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1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT;AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
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APPLICATION
APPROVAL
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THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This app
calicin is not it perrym tinjilsigii(i(i I)y ItIt,
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Offi(al
or 111%ittif DIJI)UIY alid afe paid and
IN VIOLATION OF THE LABQP
�CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
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SIGN I VRIWNE�
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771-0220
REL\AS�D
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ATTENTION e—) 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. UBC109 / IBC110 f IRC1`10.
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