20050713.pdfDATE RECEIVED [PERMIT EXPIRES
S.,
PERMIT f
CITY OF EDMONDS NUMBER
112-04,2-
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APTN
OWNER NAMEINAME OF BUSINESS ADDRESS 7
_Tom LAWJ?�Oyq Ce PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
W MAILING ADDRESS LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPAppirrived
RW Permit Required E3
Street Use Permit Required M
CITY TELEPHONE EXISTING PROPOSED Insriection Required 13
SIri Required E3
REQUIRED DEDICATION FT Uneurgmund E3
EDMOA105i, Wirinq required E3
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES 13 NOM z
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STATE LICENSE NUMBER EXPIRATION DATE e�tCk Y VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
_0_7 k REO'D COMPLETED I EXEMPT
113YES 13N
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1:1 NEW RESIDENTIAL PLUMBIN<1 0 rECIH LOT COVERAGE REQUIRED SETBACKS (FT) ROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR' FRONT URSIDE REAR
NC R
COMMERCIAL z
ADDITION COMPLIANC R
CHANGE OF USE
44 MIXED USE I I I — z
REMODEL PARKING IDED LOT AREA FANNING REVIEWED BY DATE
MULTIFAMILY SIGN REO'D PROV
GRADING FENCE
REPAIR CYDS —.X FT) REMARKS
DEMOLISH TANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
z CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY). V.-LAIl$ ---
TYPE
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Lu NUMBER NUMBER OF
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OF DV ELLING SPEC&L INSPECTION CONSULTANT OCCUPANT
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DESCRIBE WORK TO BE DONE Ivo /�ja REMARKS
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Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE LOT SLOPET___7 VESTED DATE Building Permit City Surcharge
16�0 t-51
PLAN CHECK NO:
Plumbing f3ase Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
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 Fire Review Plan Chk. Deposit
HEIRS, ASSIGNS AND SUCCESSORS
uj
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDM DS, 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 Landscapelnsp. Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- �2
Recordin Bl.ipt #
__I Rem 12110
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 hisihor Deputy: and Foes are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABO8,110DE OF THE STATE OF WASHINGTON RELATING TO �OR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATIQ)tfNSURANCE AND RCW 18:27.
OFFICII
jALS I NA
SIGNAY!9 (OWNER OR ENT): IATE SIGNED (425) F9 I
//) V10\,, (/J/
771
ATTEWION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UN IL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CER I-
, I
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC11
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