20050804 (2).pdfDATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
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CITY ZIP (T`E�L/E�P/HO1NE �J 2 C
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NAME
ADDRESS
ADDRESS
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CITY ZIP TELEPHONE
SeatF�e 9813'4 2o�423-�IZ2
PERMIT EXPIRES
PERMIT
NUMBER
JOB SUITE/APT#
ADDRESS
q0 3 M0,11/1 S4r AdS W✓4
PLAT NAME.ISUBDIVISION NO. LOT NO. LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Appravod O
RW Permit Required E3
EXISTING PROPOSED Street use Permit Requited
Inspection Required
SidewalR Required
REQUIRED DEDICATION FT rindergrnund CI
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METER SIZE LINE SIZE NO, OF FIXTURES PRV REQUIRED
YES 13 N013 z
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OWNEWCONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE _
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ENGINEERING REVIEWED BY DAT
FIRE REVIEWED BY DATE w
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STATE LICENSE NUMBER EXPIRATION DATE C KED BY VARIANCE OR CU SHORELIINNEE OR ADB# INSPECTION SE
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PROPERTY TAX ACCOUNT PARCEL NO. CA# _ �- ZONE SIGN AREA HEIGHT
WWAIVER 13 `, ALLOWED PROPOSED ALLOWED PROPOSED
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NEW RESIDENTIAL PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LJR SIDE REAR
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ADDITION /❑ MIXED USE CHANGE OF USE Z
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PARKING LOT AREA - PLANNING REVIEWED BY DA EEl REMODEL. MULTIFAMILY IGN REO'D PROVIDED`—/:��IGRADING ❑ FENCE X FT.) REMARKS i/, S
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REPAIR CYDS (
DEMOLISH F1 TANK 1:1 OTHER
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CARPORT ❑ . ROCKERY WALL 1:1FIREALARM RINKLER
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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TYPF JCON TRUC ION ' OD GOCC ROUPANT6
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m OF / DWELLING SPECIAL INSPECTION CONSULTANT OCCUNT
oSTORIES UNITS LOAD2
DESCRIBE WORK TO BE DONE REQUIRED YES
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rn 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
UJI 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 1 HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. 1 AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• This application Is not a permit until signor by
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy: and Fees aro paid,d,
and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27,
C F ALS SIG TU E ATE
TUR WNER O ENT) DATE SIGNED c (425)
771 -022 R �) BY / D rE
AT ENTI N 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•
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC1091 IBC1101 IRC110s ORIGINAL -FILE YELLOW - IIJ ESS R
PINK -OWNER GOLD -ASSESS R
10104. PRESS HARD - YOU ARE MAKING 4 COPIES
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Description FEE
Description FEE.
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Plan Check �'
State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE
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Building Permit
City Surcharge
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PLAN CHECK NO:010OF
Plumbing
Base Fee.
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
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DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
Grading
SEPARATE PERMISSION,
Engr. Review
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PERMIT APPLICATION: SEE ECDC 19,00.005(A)(5)
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PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
Engr. Inspection
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SEE BACK OF PINK PERMIT FOR MORE INFORMATION
rn 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
UJI 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 #
Ix
< 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 1 HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. 1 AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• This application Is not a permit until signor by
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy: and Fees aro paid,d,
and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27,
C F ALS SIG TU E ATE
TUR WNER O ENT) DATE SIGNED c (425)
771 -022 R �) BY / D rE
AT ENTI N 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•
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC1091 IBC1101 IRC110s ORIGINAL -FILE YELLOW - IIJ ESS R
PINK -OWNER GOLD -ASSESS R
10104. PRESS HARD - YOU ARE MAKING 4 COPIES
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