20050691.pdf% DATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ER NAMEINAME OF BUSINESS
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II(Irl 4 PERMIT EXPIRES,�`� 61,
PERMIT
NUMBER
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ADDRES /'31 2 � % n )
PAT NAME/SUBDIVISION NO.LOT N LID NO. G/
LID FEE 5
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved Q
RW Permit Roqu17
Street Use Parma trod Required E I
EXISTING LREMARKS
PROPOSED Inspection Required L7
Sidewalk Required �TION FT underground O—•— Wem reuired
LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES0 NOCI z
w WTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE z
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NAM bh)/E1
4 (�/C.- / �(C ENGINEERING REVIEWED BY DATE
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FIRE REVIEWED BY DATE
CITY ZIP TELEPHONE
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STATE LICENSE NUMBER EXPIR TION DATE CH CKED BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
/ / _ REQ'D COMPLETED EXEMPT
� YES ONO
CAN ZONE=SIGNREA HEIGHT
Q^onOrPTYTAXACCOUNT ,RCEL NL;WAIVERS PROPOSED ALLOWED PROPOSED
1 STUDY 0
❑ NEW ❑ RESIDENTIAL ❑ PLUMBING/ MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
COMMERCIAL COMPLIANCE OR
❑ ADDITION ❑ CHANGE OF USE
MIXED USE
❑
REMODEL ❑ PARKING LOT AREA PLANNING REVIEWED BY DATE MULTIFAMILY ❑ SIGN REQ'D PROVIDED
❑❑ GRADING ❑ FENCE X FT.) REMARKS
REPAIR CYDS
DEMOLISH ❑ TANK ❑ OTHER
z ❑GARAGE RETAINING FIRE
. CARPORT ❑ . ROCKERY WALL ❑ FIRE ALARM SPRINKLER
0
(TYPE OF USE, B ESS O ACTIVITII E PAIN:
TYP OF 0NSTRUCTION COD OCCUPANT
v GROUP
w NUMBER NUMBER OF
mOF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
O STORIES UNITS A/ LOAD
REQUIRED O YES
DESCRIBE WORK TO BE DONE
(J ' RE ARK
%
GEOTE P R %
BY:
S(OA STRUCTURAL DES GN
BY:
VALUATION
Description Fqescription FEE
Plan Check te Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE
Building Permit y 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
J SEPARATE PERMISSION,
Engr. Review
w PERMIT APPLICATION: SEE ECDC 19.00,005(A)(5)
CL PERMIT LIMIT: SEE ECDC 19,00,005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. If1SpeCtlOn
*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
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 # ,
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND TtVIT 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 PLY WITH CITY AND ST TE LAWS REGULATING CONSTRUC•
TIO ANO IN DOING T W RK AUTHOR E HE Y, NO PERSON WILL BE EMPLOYED GALL Building Official or his/her Deputy: and Fees are paid, and
INV LATION OFT BOR ODE E OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged m space provided.
W N'S COMP S ION I U A 18:27.
001 ALS SIG AT RE DAJE
SIGN UR RORA V D O (425) u j
J.4/7.000V Lo�7 (x1 '0220 REE ED BY DAT
ATT. TION EXT. 1333
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 I IBC110 / IRC110. PINK -OWNER GOLD ASSESSOR
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