20050697.pdfDATE RECEIVED
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CITY 09 EDMONDS* X,
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CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
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OWNER NAMEINAME OF BUSINESS
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- .,3 c.:5 1V RW Permit Required 13
CITY ZIP TELEPHONE EXISTING Street Use Permit Required 0
PROPOSED Inspection Required [3
Sidewalk Required C3
473 REQUIRED DEDICATION FT underground E3
led 13
NAME T METER SIZE LINE SIZE NO. OF FIXt REQUIRED
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U OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLdDRAINAGE
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STATE LICENSE NUMBER EXPIRATION DATE C"A' VARIANCE OR CU SHORELINEORADB# INSPECTION SEPA
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19 NEW RESIDENTIAL LUMBING UM LOT COVER E REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
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1 ADDITION 14 COMMERCIAL COMPLIANCE OR 0
:1 E] CHANGE OF USE 3
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1:1 REMODEL PARKING LOTAREA PLANNING REVIEWED BY YT� 5
1:1 MULTIFAMILY 1:1 SIGN REQ*D PROVIDED e S7 SL
GRADING FENCE N
REPAIR 1:1 CYDS 0 ( X _. FT.) REMARKS
DEMOLISH 1:1 TANK 1:1 OTHER /v%1C4,%etn o'
GARAGE RETAINING WALL FIRE SPRINKLER V1.1 6, 14 S k4m A0 i- C,�PA it- Amn)it. psih�
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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:
/Z-1 / Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK N 'HIS PERMIT COVERS WORK TO Mechanical
t= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
�ngr. Review
PERMIT APPLICATION: SEE ECDC 19-00.005(A)(5)
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PERMIT LIMIT: SEE ECDC 19,00-ODS(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
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection Receipt #
< ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
-0i DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp., 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 I HAVE READ THIS APPLICATION; THAT THE INFORMATION I 1 1 �2 70, .�4
GIVEN IS CORRECT;AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application is not a permit until signed by the
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 receipt is acknowledged in space provided
WORfiMEN'S (NMPENSATI=NCE AND RCW 18:27. OFFICIALS SIGNATURE DA
L= SIGN URE (I.ER GE DATE SIGNED (425)
771-0220 AELEfiS�D BY AT E//
ATTCNTION EXT. 11333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110. ORIGINAL -FILE YELLOW -/NSPECTOR
PINK -OWNER GOLD - ASSESSOR
110104 PRESS HARD - YOU ARE MAKING 4 COPIES
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