20050791.pdfI
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWIJER NAMEINAME OF BUSINESS
MAILING ADDRESS
'71) -3
CITY ZIP
n/Lds lyv�6
NAME
ADDRESS
NEW
0 ADDITION
1:1 REMODEL
1:1 REPAIR
DEMOLISH
z
C]GARAGE
CARPORT
(TYPE OF USE,
L
R
L)
in
w NUMBER
OF
STORIES
OW
CBL#
TELEPHONE
24Dr,o
UMBER LAHIKA] I
CCO T PARCEL NO,
rf
IL)
PERMIT EXPIRES -
PERMIT
6`7 c1l
NUMBER c2clos`--
JOB UITEIAPT#
ADDRESS
0
PLAT NAME/SUBDIViSION NO.
LOT NO,
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPAppmved [3
RW Permit RetiLtrod 13
EXISTING PROPOSED
Vern. I
*M6j1JrseP6rTF0 Requited E3
IrApoct,on Rrtqu�ied 13
ultdd
LAtdr Wal
UV, ir , ",u I-, j 13
REQUIRE9DEQUOP
% az::�
.. led I_ -
METER
kEbft!)r
KX Ng"khWAt;
PRV RE6UIRED
NO C1
CPO z
Lu
W
REMARKS z
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE i 6
1
vent connectors i4equi
a
an.wei-Durnma aj)pliances passnig
FIRE REVIEWED BY
DATE
BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
REO'D COMPLETED I EXEMPT
10YES 13NO I
CA# ZONE SIGN AREA HEIGHT
,WAIVER 13 ALLOWED PROPOSED ALLOWED , PROPOSED
STUDY 13 1
LOT COVERAGE REQUIRED SETBACKS 'FT.) PROPOSED SETBACKS (FT.)
RESIDENTIAL x PLUMBING I MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
COMMERCIAL COMPLIANCE OR
z
MIXED USE CHANGE OF USE I I I z
PARKING LOTAREA PLANNING REVIEWED BY DATE
�A
n
MULTIFAMILY
GRADING
CYDS
TANK
RETAINING WALL
ROCKERY
Lj
Ei
Sl G N
FENCE
( X. FT.)
OTHER
FIRE SPRINKLER
FIRE ALARM
R E O'Do
PROVIDED
REMARKS
IESS OR ACTIVITY) EXPLJMN. TYPE OF CQNSTRUCTION E OCCUPAN
GROUP
NUMBER OF __YWI�b c6tZ) lf�
DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
BE DONE UNITS REQUIRED LOAD
REMARKS
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
4111LI11b VALUATION
no;,71-1 A, �? f $
a
z
A)
L1AJW- In
scription
FEE
Description
State Surcharge
City Surcharge
FEE
A"VESTED
Plan Check
HEAT SOUPCE
LOT SLOOE%
DATE
Building Permit
PLAN CHECK NO:
Plumbing
Base.Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
C7�,4_U
Grading
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
Engr. Review
SEPARATE PERMISSION.
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
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
i 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
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapelnsp.
Total Arrit. Due
3 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.6
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION...
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
This application is riot 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
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
receipt is ackno#edged in space provided.
FOR INSPECTION
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
OFFICIALS G ATURE ATE
siGNATURE(O ERUOG T)I,: DAT SIGNED
(425)
771-0220
RELE S BY It DhTE��
ATTENTION
EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY eBUILDING 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 11 IBC110 I IRC110.
PINK - OWNER, GOLD - ASSESSOR
i o/04 PRESS HARD - YOU ARE MAKING 4
COPIES
z
0
1
0
M
-n
M
C
M
0
-40
0 C:
M
M Z
C _z
3:
o -n
ri
-4
x
M M
0
0
0 rn
cl)
Cn
Q 0
Z
3:
z
C0
Z.
0
1
0
ITI
a