20050560.pdf�^JIM
DATE RECEIVED
PERMIT EXPIRES' L
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PERMIT /�1=
CITY OF EDMONDS NUMBER C
CONSTRUCTION PERMIT APPLICATION JOB SUITEIAPT#
ADDRESS L`
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OlirtiAMEINAME OF BUSINESS �1 t `L C�C� 1V\ o J��
PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
x MAI ING ADDRESS LID FEE 5
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW PermitReqApproved O
RW Permit Required 0
Sheet Use Permit Required 13
CITY ZIP TELEPHONE EXISTING PROPOSED _ _ Inspection Required O
7 , _ Sdowalk Required 17
%��� REQUIRED DEDICATION FT underground O
Weinrequired
NAME METER SIZE LINE SIZE NO, OF FIXTURES PRV REQUIRED
YES I3 NO i3 Z
W K
ADDRESS REMARKS w
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x OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE _
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CITY ZIP TELEPHONE
NAME CBL#
C" W ENGINEERING REVIEWED BY DATE
tr ADDRESS v
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CITY ��!} FIRE REVIEWED BY DATE
U ` (5, ZIP TELEPHONE �,L � r7�� u�-
STATE LICENSE NUMBER EXPIRATION DATE BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
��•••• U REQ'D COMPLETED EXEMPT
OAR K - 0 YES 13N0
-' PROPERTY TAX ACC NT ARCEL NO.
CAN 7.0NE SIGN AREA HEIGHT
Q ✓- WAIVER O ALLOWED PROPOSED ALLOWED PROPOSED
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� STUDY 13
❑ NEW ❑ RESIDENTIAL1:1PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR O
COMMERCIAL COMPLIANCE OR _
❑ ADDITION MIXED USE 1:1CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY DATE ga
REMODEL ❑ MULTIFAMILY 13 SIGN REQ'D PROVIDED
❑ GRADING 13FENCE
❑
REPAIR CYDS ( X FT.) REMARKS
❑ DEMOLISH ❑ TANK 1:1 OTHER
_ ❑GARAGE RETAINING WALL
CARPORT ❑ ROCKERY IREALARM
a (TYPE OF USE BUSINESS OR ACTIVITY) EXP AIN:.
� \ TYPE F ONSTRUCTION CODE GOCCUP
ROUPANT L+�
UP) NUMBER ��'�- NUMBER OF 37A V1h
m OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
° STORIES ` . UNITS LOAD
-i REQUIRED 0 YES
DESCRIBE WORK TO BE DONE
REMARKS t7
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-1.� L✓ �'�� GEOTECH.REPORT m
BY:
`Lq/ V �,�" J t •rtr STRUCTURAL DESIGN
BY:
VALUATION
$
Description FEE Description FEE
Plan Check 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
t SEPARATE PERMISSION.
Engr. Review
w PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
n• PERMIT LIMIT: SEE ECDC 19,00,005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engf. Inspection
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U) •APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fife Review Plan Chk. Deposit
U.1 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 #
s 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.•
x In
Recording Fee Receipt # t
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 COMPENSATIPW4illiSURANCE AND RCW 18:27,
FFICI L N URE DA E
ATURE (OWNER OR NT) DATE SIGNED (425) '
771 0220 R•CE ED BY ATE
ATTE N EXT. 1333 `
ITIS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL /��
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL - FILE YELLOW - I SPEGTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109I IBC110 I IRC1106 PINK -OWNER GOLD - ASSESSOR
10104 1 PRESS HARD- YOU ARE MAKING 4 COPIES
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