20050731.pdfB/ DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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STATE LICENSE NUMBER EXPIRATI N DATE D
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PROPERTY TAX O NT PARCEL NO. 40 � 9
❑ NEW ! RESIDENTIAL , `h[l PLUMBIN MECH
COMMERCIAL COMPLIANCE OR
❑ ADDITION ❑
MIXED USE CHANGE OF USE
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN
❑
REPAIR ❑ GRADING ❑ FENCE
CYDS
FPERMIT EXPIRES
PERMIT
NUMBER i o
JOB SUITE/APT#
ADDRESS
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PLAT NAME/SUBDIVISION NO, LOT NO. 6A NO
LID FEE 5
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved O
3
RW Pernid Required I]
Street Use Pormd Requeod IJ
EXISTING PROPOSEDinspection Required O
Sidewalk Requited 17
REQUIRED DEDICATION...FT Underground O
Wiring required fJ
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES D NOD Z
WW
REMARKS W
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE z
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ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE W
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VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA a
BY REQ'D
COMPLETED EXEMPT
1+d411 1h1 A? Py0''`v OYES NO X
CA# ZONE SIGN, AREA HEIGHT
WAIVER O ALLOWL'D PROPOSED ALLOWED PROPOSED
STUDY o NA 2)N.. � None 3b" 33.1!,
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
i Nlc, Ivune if < S6011 Reovoc9ht• z
Z
PARKING LOTAREA PLANNING REVIEWED BY DATE
REQ'D . PROVIDED
l N L soppappeI Q'S
( X FT.) REMARKS X, aJ G I a (L
OTHER �
❑ DEMOLISH ❑ TANK ❑ 1 ` � Y�� CJLJC..J
❑GARAGE RETAINING WALL FIRE SPRINKLER 'l
CARPORT ❑ ROCKERY ❑ FIRE ALARM w� - I�oN.w\ /^' j� '' ��/k .T
(TYPE OF USE, BUSINESS OR ACTT EXP IN: L4 dA ✓ ���^r• o 1 dkL UA �•
i' TYPE OFCSNSTRUCTION CODE GROUPANT
CNUMBER NUMBER OF
OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
o STORIES UNITS LOAD
D SCRIB WOR O BE DONE ' n ^ ^ REQUIRED YES
-f!il� W v 1 REMARKS z
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-0 GEOTECH REPORT O
BY: Map
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1I/ STRUCTURAL DESIGN
BY:
VALUATION
$
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE
Building Permit City Surcharge
PLAN CHECK NO: Plumbing Base Fee
LAJ
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
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SEPARATE PERMISSION, Engr. ReVIBW
w PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
d PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION l=ngr. Inspection
WON
'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
F.OMONDS, 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 r
Landscape Insp. Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Recording Fee Receipt # p�
I HEREBY ACKNOWLEDGE THAT 1 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 OW EE TO COMPL CITY AND STATE LAWS REGULATING CONSTRUC• CALL Building Official or his/her Deputy: and Fees are paid, and
TIO 0 IN 001 THE WORK UTHO EO THEREBY, NO PERSON WILL BE EMPLOYED receipt is acknowledged in space provided.
IN IDEATION THE LABO CODE O THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
RKMEN'S MPENSAT URANC AND RCW 18:27. rRELEASED
G TURE ATE
S (OWN O GE DA IGNE r� •x(425) 7 / 1 -0220 DAT
ATT N EXT. 1333 d
IT IS UNLAWFUL TO USE OR OCC PY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- RIGINAL .QLEYELLOW -IN PECTFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110, INK • OWGOLD ASSESSOR
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