20050736.pdfDATE RECEIVED
PERMIT EXPIRES
CITY OF EDMONDS NUMBERC�_�����
CONSTRUCTION PERMIT APPLICATION
JOB
� SUITEIAPTa
OWNER NAME/NAME OF BUSINESS 3 l
oI ; ;�00 (� l ` Q PLAT NAMEISUBDIVISION NO. LOT NO. LIG NO.
t /1 rj^�— LID FEE 5
MAILINGSS ,1r tr. RW Po ma Approved ❑
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP kyr Pnrmn Required ❑
Street Use Permd Rogwred
CITY ZIP TELEPHONE EXISTING _ PROPOSED _ inspociion Requuua
r • Sduwalk Requited
e I,, 2 U ❑
5 qGa v �� 1C/ �✓ l l / REQUIRED DEDICATION FT Undergroundwumro ueod C3
NAME METER SIZE LINE SIZE_ NO. OF FIXTURES PRV REQUIRED
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/. YES O NO ❑ K
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Lu W
1= ADDRESS REMARKS z
x OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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NAME C
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ITY ZIP TELEPHONE LL
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EXPIRATION DA CHECKED BY VARIANCE OR CU SHORELINE OR ADBa INSPECTION SEPA
STATE LICENSE NUMBER
_— REQ'D COMPLETED EXRIPT
O YES ill. NO X
CAa _ ZONE SIGN AREA AaM I`EIGHT
a PROP^E�RTY TAX ACCOUNT PAR'CEL NO.O. WAIVER ALLOW PPROPOSEDn�iLOWE PROPOSED
W `
�� 0d 00 co STUDY pit 9
IDENTIAL pLl1MBING / MECH LOT COVERAGE REQUIRED SETBEREART]
PR POSED CKS ( .)
❑ NEW �o ❑ ALLOWED PROPOSED FRONT SIDE�FoR.O�NT LIR SIDE REARAD
❑ COMMERCIAL COMPLIANCE OR 3 r' NIL 2O 5T`� r � y 31 Ij��B2
❑ ADDITION ❑ MIXED USE ❑ CHANGE OF USE _
PARKING LOTAREA PLANNING REVIEWED BY DATE g
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REQ'D PROVIDED
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GRADING FENCE ' G 0 -Is 0$ OLH
❑ REPAIR ❑ CYDS 4*( X FT) REMARKS
❑ DEMOLISH ❑ TANK �OTH l' '
Z ❑ RETAININGGARAGE FIRE LER
CARPORT ❑ RO KERY WALL ❑ FIREALARM
P (TYPE OF USE, BUSINESS OR ACTIVI Y) EXP IN:
F CONSTRUCTION C0011 GROUPANT
I V
ul NUMBER O
O OF DWELLING
DWELLING SPECIAL INSP CTION CONSULTANT OCCUPANT.
M STORIES. ) UNITS LOAD
REQUIRED 13 YES
DESCRIBE WORK TO BeDONE
RE)*RKS Q
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Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE LOTSLOPE° VESTED DATE
Building Permit City Surcharge �
PLAN CHECK NO: Plumbing Base Fee
Mechanical .06
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE'DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC Grading
II
7 DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
t SEPARATE PERMISSION.
Engr. Review
oft PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
it PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'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
EDMON IS, 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.'
y 2L
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 FOR INSPECTION receipt is acknowledged in space provided.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S SATION INSURANCE AND RCW 10:27. OFFICIALS SIGNATUREDAT
SIGNATU E W G T) DATE SIGNED ��„ (425) ��j
&�
-�� 771 -0220 RELEAS D BY D TE
ATTENTION EXT. 1333251p�
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL -FI YELLOW I SPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 I IRC110, PINK -OWNER •GOLD S ESSOR
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