20050787.pdfDATE 4ECEIVEO 7
PERMIT EXPIRES _ 1
PERMIT
CITY OF EDMONDS NUMBER L'►C O% G
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
ADDRESS
OWNER NAME 17AME O BUST TESS �
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OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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PROPERTY TAX ACCOUNT PARCEL NO. > CA# _j ZONE SIGN AREA HEIGHT
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❑ NEW fkC RESIDENTIAL pL NG h1ECH LOT COVERAG REQUIRED SETS S (FT.) PROPOSED SETBACKS IN
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❑ COMMERCIAL LIANCE OR
❑ ADDITION ❑ MIXED USE AI' OF USE
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❑ REMODEL ❑ MULTIFAMILY ❑ SI REO'D A
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GRADING FENCE REPAIR ❑ CYDS ❑ ( X FT.) REMARKS
❑ DEMOLISH ❑ TANK ❑ THER
❑ CARPWALL LER
ORT ❑ ROCKERY ❑ FI EALARM
FRONT SI REAR FRONf UR SIDr "REAR
AREA PLANNING REVIEWED BY TE '
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN.
TYPE / ON
NUMBER NUMBER F
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STORIES UNITS
DESCRIBE WORK TO BE DONE REQUIRED YES
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GEOTECH REPORT
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HEAT SOURCE LOT SLOPE6h E TED DATE
J Building Ci urch
PLA CHECK NO: Plumbing Base F
ANATHIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBIC
F DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC,) WILL REQUIRE Grading
SEPARATE PERMISSION,
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PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
L PERMIT LIMIT: SEE ECDC 19,00.005(A)(6) Ins n
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire 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 Inspe n 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 In Total Amt, Due
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' n
Recording Fee Receipt #
1 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. 1 AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• CALL Building Official or hislhor Deputy: and Fees are paid, and
TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LAB -FODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided
WORKMEN'S COMPENSA309IIWIRANCE AND RCW 18:27. OFFICIAL$ SIGNATURE PATE
SIGNW
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DATYGND (425)I1
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771 -0220 RELEASED Y DfrE'
AlftEINTION 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 -INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109 I IBC110 I IRC11.0. PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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