20050789.pdf! DATE RECEIVED
CITY OF EDMONDS
FMAILING
STRUCTION PERMIT APPLICATION
NAME OF B SIN7S
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PAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREE �. RW Pn m w� ❑
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YES 13 NO O O
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OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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PROPERTY TAX ACCOUNT PARCEL NO. (J WAIVER 0 BE 1�F�')1�'�" SED ALLOWED PROPOSED
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RESIDENTIAL LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
❑ NEW PL 81 MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT. L/R SIDE REAR O
❑ COMMERCIAL COMPLIANCE OR z
❑ ADDITION. ❑ CHANGE OF USE z
❑ MIXED USE PARKING LOT AREA PLANNING REVIEWED BY DATE a
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REO'D PROVIDED
❑ REPAIR ❑ GRADING CYDS ❑ FENCE X FT.) REMARKS
❑ DEMOLISH C]TANK ❑ OTHER
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CARPORT ❑ ROCKERY GE RETAININGWALL ❑ FIREA ARM SPRINKLER
a (TYPE OF USIE. BUSINE5S OR ACTIVITY) EXPLAIN:
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c NUMBER NUMBER OF
OF DWELLING SPECIALSPECTION CLOAD
ONSULTANT OCCUPANT
UNITS
O STORIES REQUIRED YES
DESCRIBE WORK TO BE DONE
REMARKS t7
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IT. VI STRUCTURAL DESIGN
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41 l%' / /7 VALUATION
`r Cab' aDescription FEE . Description FEE
Plan Check Staie Surcharge
HEA SOUR E LOTSLOPE% VESTED DATE
Building Permit City Surcharge 15 0000
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PLA HECK NO:,. Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO ME ChanICBI r/7
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE. PUBIC Gradin
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) 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
EDMONDS, 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 f
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 #
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT 1 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 FOR INSPECTION receipt is acknowledged In space provided.
IN VIOLATION OF THE ODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENS I RANCE AND RCW 18:27. OFFICIALS,SI NATURE DATE
SIGNATURE WNER O EN DATE SIGN (42 S)
771 -0220 RELEAS D BY D E
A E TION EXT. 1333
ITIS 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 / IRC1100 PINK - OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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