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CITY ZIP TELEPHONE EXISTING PROPOSED _ Inspection Required O
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Description FEE Description FEE
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PLA HECK NO: / Plumbing Base Fee '50 . o
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical. O 00
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC Gradin
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g
SEPARATE PERMISSION,
Engr. Review
W PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
o PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engf. Inspection
to '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 #
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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.
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 ace provided.
IN VIOLATION OF THE LABOR CO E STATE OF WASHINGTON RELATING TO P 9 p
WORKMEN'S COMPENSATIpWT9Vd4ANCE ANP RCW 18:27, - iC SIGN E DATE
SIGNATURE (OWNE R ): DATE SI NED (425) C"'
����� 1oo, 771 aiii 'REL PD BY �~ DATE
ATTEN EXT. 1333 �'
IT
S UNLAWF TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL `j
A FINAL IN ECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL •FILE •YELLOW -INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED, USC109I IBC110 I IRC110• PINK -OWNER GOLD - ASSESSOR
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLDRAINAGE
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OO ADDRESS ----
Q FIRE REVIEWED BY DATE
zCITY ZIP TELEPHONE W
c� q 1 rse3 9 LL
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BYECA#
SHORELINE OR ADB# INSPECTION SEPA
OW REQ'D COMPLETED EXEMPT
O YES f7 NO
PROPERTY TAX ACC�UN7 P CEL NO. ZONE SIGN AREA HEIGHTQ - ALLOWED PROPOSED ALLOWEDPROPOSEDCD 0%� %�Lu V - 5
❑ NEW ❑ RESIDENTIAL PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) {
P ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
0
COMMERCIAL COMPLIANCE OR z
❑ ADDITION ❑ CHANGE OF USE z
MIXED USE PARKING LOT AREA PLANNING REVIEWED BY DATE g
REMODEL ❑ MULTIFAMILY ❑ SIGN REQ'D PROVIDED
GRADINGFENCE j
?KlombEPAIR 13CYDS ❑ ( X FT.) REMARKS
T OTHER
❑ DEMOLISH ❑ TANK ❑
Z ElGARAGE RETAINING WALL 11FIRE ALARM LER
CARPORT ❑ ROCKERY
a(TYPE OF USE, BUSINESS OR ACTIVITY) EX .AIN:
iREQUIRED
TRUCTION CODE OCCUPANT
i coi GROUP
w NUMBER NUMBER OF
m OF DWELLING - PECTION CONSULTANT O CUPA T
O STORIES -I^ PY fz� UNITS YES LOAD
DESCRIBE WORK TO BE DONE
REMARKS ?
GEOTECH REPORT m
BY:
sJ STRUCTURAL DESIGN
BY:
VALUATION
y
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE LOT SLOPE%: VESTED DATE IS
0
G Building Permit City Surcharge 1
,�
PLA HECK NO: / Plumbing Base Fee '50 . o
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical. O 00
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC Gradin
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g
SEPARATE PERMISSION,
Engr. Review
W PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
o PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engf. Inspection
to '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 #
Ir
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.
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 ace provided.
IN VIOLATION OF THE LABOR CO E STATE OF WASHINGTON RELATING TO P 9 p
WORKMEN'S COMPENSATIpWT9Vd4ANCE ANP RCW 18:27, - iC SIGN E DATE
SIGNATURE (OWNE R ): DATE SI NED (425) C"'
����� 1oo, 771 aiii 'REL PD BY �~ DATE
ATTEN EXT. 1333 �'
IT
S UNLAWF TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL `j
A FINAL IN ECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL •FILE •YELLOW -INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED, USC109I IBC110 I IRC110• PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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C l"
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_ M
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