20050568.pdf6
"'I DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NiNAME OF BUSINESS
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MAILING ADDRESS
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CITY ZIP TELEPHONE
NAME
CITY
STATE LIC
NEW
ADDITION
REMODEL
REPAIR
DEMOLISH
GARAGE
CARPORT
(TYPE OF USE. BI
WK1=1
IL
ZIP
EXPIRATION DATE
NO: .
RESIDENTIAL
C COMMERCIAL
E]
MIXED USE
MULTIFAMILY
GRADING
CYDS
TANK
RETAINING WALL
ROCKERY
OR ACTIVITY) EXPLAIN
NUMBER 0
25--71
PERMIT EXPIRES
PERMIT
NUMBER
1�
JOB
ADDRESS
SUITEiAPT#
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PLAT NAMEISUBDIVISION NO.
LOT NO
LID NO
I
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
13
13
RW Permit Recuired
Street Use Porniii Requoied
EXISTING PROPOSED
inspection Required
Sidewalk Requirtid
C3
R I EQUIRED DEDICATION
FT
untiorg(ound
Wiring required
C3
METER SIZE
LINE SIZE
NO OF FIXTURES
PRV REQUIRED
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REMARKS
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OWN ERIC PNjqACTOR RESPONSIBLE FOR
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ENGINEERIjG1V7.VI1WL-" UAI t
% 'IV" -L 'Ve'll connectors required
On fuLl-but'riling applialiccS Tincy nCT
RY&Pugl"1111hetted spaces.
FIRE REVIEtt. W
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VARIANCE OR CU SHORELINE OR ADB,1 I INSPECTION SEPA
REO'D COMPLETED EXEtAPT
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WAIVER 13 pUR�Sk, L ED PROPOSED ALLOWED , PROPOSED
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LOT COVERAGE sm TBACKS (FT.)
M-V PLUMBING if MECH ROPOSEDS kiv-4
Ad5l< ALLOWED P Uiml UqON TOE REAR
ElCOMPLIANCE OR L AS IT IENTEMM BUILDING
CHANGE OF USE mi
PARKING LOT ARETTNNING REVIEWED BY DATE
SIGN REO'D I PROVIDED
FENCE
( X FT.) REMARKS
OTHER
FIRE SPRINKLER
FIREALARM I
GROUP
ED
OF
DWELLING
SPECIAL INSPECTION
CONSULTANT
OCCUPANT
LOAD
0
STORIES
UNITS
REQUIRED 13YES
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GEOTECH REPORT
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Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE
LOTSLOPE%
VESTED DATE
Building Permit
City Surcharge
PLAN CHECK NO:
Plumbing
--efo
.
Base Fee
Mechanical
/01,
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Grading
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
Engr. Review
SEPARATE PERMISSION.
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PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
0.
PERMIT LIMIT., SEE ECDC 19.00.005(A)(6)
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
to S
in 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSOR
Fire Review
Plan Chk. Deposit
Lu IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
_j
2 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
LandscapeInsp.
Total Amt. Due
IReceipt
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
`01
Lgo
Recording Fee
c #
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.
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
CALL
Building Official or his/her Deputy: and Fees are paid. and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
(--,.,receipj�cknowledgecl it space providLd
WORKMEN' S COM PEN SA;>kt.�\URANCE AND RCW 18:27.
OFF e R
.
SIG ATU (OWNEKdhAGENT)_?tii DATE SIGNED
(425)
WGU
7 71-0220
IPATE L
ATTE14TION
EXT. 1333
JRELEAS��j
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
ORIGINAL - FILE - YELLOW - INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC1110 if IRC1110.
PINK -OWNER GOLD - ASSESSOR
10/04 PRESS HARD - YOU ARE MAKING 4 COPIES
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