20050620.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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NAME
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PERMIT EXPIRES
PERMIT
NUMBER C6
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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STATE LICENSE NUMBER
-7 0"o
EXPIRATION DATE
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ALLOWED I PROPOSED ALLOWED , PROP06ED
PROPERTY TAX ACCOUNT PARCEL NO.
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RESIDENTIAL
COMMERCIAL
MIXED USE
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MCPLUMBING if MECH
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. LOT COVERAGE RE UIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT I REAR
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PLANNING REVIEWED BY DATE
5eREPAIR
GRADING FENCE
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REMARKS
DEMOLISH
TANK
OTHER
GARAGE
CARPORT
RETAINING WALL FIRE SPRINKLER
ROCKERY FIREALARM
(TYPE OF USE, BUSIN S R ACTIVITY) EXPLAIN:
TYPENhCC STRI CTION
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OCCUPANT
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NUMBER NUMBER OF I —
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OF DWELLING SPECbAL I=tr UPANT
STORIES UNITS REQUIRED 13 YES LOAD
DESCRIBE WORK TO BE UONE
REMARKS
GEOTECH REPORT
BY:
AT24 STRUCTURAL DESIGN
BY:
VALUATION
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOII LOPE7__
LOT S VESTED DATE Building Permit City Surcharge
PLAN CHECK NO: Plumbing Base Fee
Mechanical oc
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC Grading
5 DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION. Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
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PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr, Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-APPLICANT, ON 13EHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Pla n Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
E EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt
y ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
it
r 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
0 NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
x Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION AP13ROVAL
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/hor Deputy: and Foos are paid. and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED receipt is acknowledged in space ed
IN VIOLATION OF THE LA� �RCODE. Of—THE,,STATE OF WASHINGTON RELATING TO FOR INSPECTIOk provid
WORKMEN'S COMPENSfM I RM AND If W 18:27. PALS S NATURE DAT
SIGNATURE __ r1Y: DATE SIGVED (425)
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OWN,W6R jxj& I )
7 771-0220 1 S 1) BY DATE
rthi�-' EXT. 1333 51
ATTEN %I
IT IS UNLAWFUL T9111SIE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
TION
A FINAL INS TION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL - FILE YELLOW INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 I IRC110. PINK -OWNER GOLD - ASSESSOR
110104 PRESS HARD - YOU ARE MAKING 4 COPIES
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