20050782.pdfDATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ER NAMEINAME OF BUSINE .S 1
NG ADDRESS
CITY
NAME
ADDRESS
ZIP I TELEPHONE
ZIP
PERMIT EXPIRES
t1UMBER
ERMIT CJ "(.' U r�
DRES SUITE/APTp
2A 83 b W01 99 &j m6 tit
PLAT NAMElSUBDIVISION NO. LOT NO. LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved d
RW Permit Required E3
Street use Permit Required O
EXISTING _ PROPOSED Inspncucn Required O
Sidewalk Required a
REQUIRED DEDICATION _ FT Underground I7
Wien re ueed O
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES O NOD z
W
REMARKS w
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE z
3
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NAME CBL#
�CT 1rV I (_ �a WA J n c 1 ENGINEERING REVIEWED BY DATE
Iz ADDRESSOR
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FIRE REVIEWED BY DATE w
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STATE LICENSE NUMBER EXPIRATION DATE IEC BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
StPOITLQ-3 �� REO'O COMPLETED EXEMPT
�—� j ~I� � YES VUQ '—..
CA# ZONE SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PAR( ELJ�OI.
v!) �j'(�'/f WAIVER 0 ALLOWED PROPOSED ALLOWED PROPOSED
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STUDY O
❑ NEW ❑ RESIDENTIAL ❑ PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR
COMMERCIALCOMPLIANCE OR z
❑ ADDITION ❑ MIXED USE ❑ CHANGE OF USE z
REMODEL ❑ PARKING
MULTIFAMILY SIGN REO'D PROVIDEDLOT AREA P NN REVIEWED BY D9T g
❑ ❑ �JJ
❑ REPAIR ❑ GRADING CYDS ❑ FENCE.
( X FT.) REMARKS
❑ DEMOLISH ❑ TANK GARAGE O
z 13 CARPORT RO KIERY WALL ❑ FIREALIRE ARMKLER
(TYPE OF USE, BUSINESI Q CTIV TY EXPLAI
CO C GROUPANT
GNUMBER NUMBER OF r
OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
O STORIES UNITS
REQUIRED D YES LOAD
DESCRIBE WORK TO BE DONE
REMARKS z
GEOTECH REPORT
BY: m
VFb STRUCTURAL DESIGN
BY:
VALUA?TION`
a CN'tn 11�ei $
Description FEE Description FEE
�.� Plan Check State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE
Building Permit City Surcharge
'PLAN CHECK NO: _
Plumbing Base Fee
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
J DONMAIN'(CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g
t SEPARATE PERMISSION.
� Engr. Review
W PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
a PERMIT LIMIT: SEE ECDC 19.00.005(A)(6),
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engf. Inspection
*APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
to
w IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
sALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscape
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due r
= NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.•
Recording Fee Receipt # I,
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 hislhor Deputy: and Foes are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED receipt is acknowledged in space provided.
IN VIOLATION OF JHE LA119B.ZODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S CO NSAT SSNCE AND RCW 18:27, C OFFICI S SIGNATURE
SIGNAT (OW O ENT). DATE SIGN (425) //6ATE
Aj
6- le9 , .771-0220 RELEASED BY / DATE
A N N EXT. 1333
IT IS U WFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FIN L INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL - FILE • YELLOW • INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC1091 IBC1101 IRC110. PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD - 'YOU ARE. MAKING 4 COPIES
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