20050683 (2).pdfDATE RECEIVED
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PERMIT Caw _ C//�i
CITY OF EDMONDS NUMBER CI1
CONSTRUCTION PERMIT APPLICATION JOB , lq�/ SUITS/APT
ADDRESS ' / /1 /!lqf is V /GL4' I(/,\�!\
OWNER NAMEINAME OF BUSINESS ` �'f (j
%7A N 1 1 PLAT NAME ISUBDIVISION NO. LOT I& LID NO
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V 1 CJ vww� I i l VVV ` RW Permit Required 13
Street Use Pennd Rogwretl 0
CITY V Zip TELEPHONE EXISTING PROPOSED_ Inspection Required O
/- Sidewalk Required 0
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Lf )4 17 r REQUIRED DEDICATION ____� FT ___ Winno required 0
NAME METER SIZE LINE SIZE NO, OF FIXTURES PRV REQUIRED
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NEW �} RESID1 LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
F.NTIAC PLUMBING MECH in
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR C
❑ COMMERCIAL COMPLIANCE OR
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❑ MIXED USE ❑ CHANGE OF USE z l (7
❑ ❑ PARKING LOT AREA PLANNING REVIEWED BY DATE S i 0 C
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El REPAIR ❑ CYDS ❑ ( X FT.) REMARKS Ifl --i
❑ DEMOLISH ❑ TANK ❑ OTHER D Z
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NUMBER NUMBER OF
OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT j=jj in
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DESCRIBE WOR TO BE DONE 0
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STRUCTURAL DESIGN
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/ ! �' Q Description FEE Description FEE =
Plan Check State Surcharge
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HE RC LOT OPE% VESTED DATE Y D oy
Building Permit City Surcharge
PLAN CHECK NO:Plumbing Base Fee M
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
cc 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 Engf. Inspection
U) *APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
W IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
a2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
q 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
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION,•
Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVA
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 AUTH ZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CU E F THE STATE OF WASHINGTON RELATING TO FOR INSPECTION A receipt is ac nowledged in space provided.
WORKMEN'S COM ATION INSU CE AND RCW 18:27. OFFI I S I AT DA7E
SIGNAT 6E (OWNER O EN DATES NED 1 (425)1)y�
771 1 =0220 RELEA BY AT
A rPPECTION
EXT 1333
IT IS UNLO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL_ -FILE YELLOW -INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109 if IBC110 I IRC110. PINK -OWNER • GOLD - ASSESSOR
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