20050717.pdfi
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PERMIT EXPIRES
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CONSTRUCTION PERMIT APPLICATION ADBSUITE/APT#
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OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS LID FEE $
L1 cov I r HT' OF WAY PER OFFICIAL STREET MAP TESCP Approval ❑
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Street Use Permd Required ❑
CIT ZIP TELEPHONE _ PROPOSED Inspection Required ❑
.•� �'j Sidewalk Required ❑
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\ / V DEDICATION FT W,r,r,, re uuud ❑NAME ) , � r�'ZE LINE SIZE NO. OF FIXTURES PRV REQUIREDYES 11 NOC1 _
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NEW RESIDENTIAL ❑ PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT)
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❑ REPAIR I CYDS ❑ ( X FT.) REMARKS r�3
❑ DEMOLISH ❑ TANK 13 OTHER
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GARAGE RETAINING WALL LJ FIRE SPRINKLER
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IL (TYPE OF USE, BCUStNESS OR ACTIVITY) EXPLAIN.
Se TYPE OTRUCTION CODE OCCUPANT
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C' OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
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DESCRIBE WORK TO BE DONE
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VALUATION
"' Description FEE Description FEE
;3 Plan Check State Surcharge J �
6 .� HEAT SOURCE LOT SLOP % VESTED DATE
27 Building Permit � City Surcharge • jam'
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PLAN CHECK NO: Plumbing ? Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
A DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
t SEPARATE PERMISSION.
r Engr. Review
w PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
a PERMIT LIMIT: SEE ECOC 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
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY ANDFire Inspection C' 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
OJ DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due "44-7
= 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 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 is acknowledged to space provided.
WORKMEN'S C07M
SATION INSURANCE AND RCW 16:27. OFFICI GN E _ DATE
DATE SIGN�^
Sl RN R R AGENT : ., SIGNED (, (425�y)
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ATTENTION 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 I SP TOR
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109 I IBC110 / IRC110. PINK .OWNER • GOLD • ASSESSOR
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