20050653.pdfi
DATE RECEIVED
PERMIT EXPIRES
PERMIT
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION jo SUITEIAPT#
ADDRE
OWNER NAMEINAMSSE OF BUSINESS
- PLAT NAME/SUBDIVISION N0, LOT NO, LID NO.
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MAILING ADDRESS K ! LID FEE $
e �/� PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved O
RW Permit Required 0
Street Use Perred Required
CITY zip TELEPHONE EXISTING _ PROPOSED Inspection Required O
(� Sidewalk Required E3
CIU REQUIRED DEDICATION FT Undwground 13
Winn re uved O
NAME MEIEslR`1,Eppe 6 NE Tz'E t C) if ttl LUA'S tI,RV REOU ED O
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tY .ADDRESS / In addition to the required
FIRE REVIE pr)essur ire ie valve, an
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. !'ly �� listed expansion tank shall 1>e
STATE
LICENSE NUMBER �%� EXPIRA'PONN DD BY VARIANC UPC
1609
pcei R REO'D COMPLETED D EXEMPT.
✓"i / V1�� V'� �[ — �JPC 'tDQ:i I3 YES NO
CA# -"�"` _."-`zdN� ' •� S�IG'N'AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO.
Q WAIVER 13 ALLOWED PROPOSED ALLOWED PROPOSED
UP
Lu a% 1;0✓04 J� ��-'�-'�—/ STUDY 13
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(� NEW RESIDENTIAL PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED. PROPOSED FRONT SIDE REAR FRONT LIR SIDE . REAR
1:1 COMPLIANCE COMPLIANCE OR i
❑ ADDITION ❑ MIXED USE 1:1 CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY DATE g
❑ REMODEL. ❑ MULTIFAMILY ❑ SIGN REOPARKING
PROVIDED
❑ FENCE
GRADING REPAIR ❑ CYDS ❑ ( X FT.) REMARKS
❑ DEMOLISH ❑ TANK ❑ OTHER
GARAGE Z ❑ CARPORT ❑ RETAINING WALL ROCKERY ❑ FIRE FIREALLER
ARM
d(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: ^�
J T ONSTRUCT N bD� GOCCUPT> 9m;
ROUP
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oNUMBER NUMBER OF
OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
O STORIES UNITS LOAD
-i REQUIRED O YES
DESCRIBE WORK TO BE DONE
REMARKS z
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GEOTECH REPORT �
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BY:
STRUCTURAL DESIGN
BY:
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VALUATION
$
u Description FEE Description FEE
4 6? Plan Check Stale Surcharge
HEAT SOURCE L T SLOPED/ VESTED DATE
Building Permit City Surcharge
PLAN CHECK NO: Plumbing L (D U Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO raMBChanICBI
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC Grading
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC,) WILL REQUIRE g
t SEPARATE PERMISSION.
� Engr. Review
W PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
a 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
i 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 Landscape Insp. Total Amt. Due
NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee Receipt # M11111111 m2m;
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' �cknowtedged In space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27,
AT
OALS T E i
SIGN RE (OWNE GE DATES NED FF(425)
li�t� �1(.1-�' �• / 71 -0220 RELEASED DATE
T NTION EXT. 1333
IT IS UNLAWFUL TO USE ORO COPY 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 / IBC110 / IRC1104 PINK -OWNER GOLD ASSESSOR
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