20050807.pdfDATE RECEIVED
PERMIT EXPIRES
PERMIT
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APTH
ADDRESS
OWNER NAME/NAME OF BUSINESS D W
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
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MAILING ADDRESS I LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPAppioved [3
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street use NMI Required E3
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PROPERTY TAX ACCOUNT PARCEL NO. WAIVER 13 ALLOWED PROPOSED ALLOWED PROPOSED
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LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
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COMMERCIAL COMPLIANCE OR z
ADDITION 1:1 z
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PARKING LOTAREA PLANNING REVIEWED BY DATE
1:1 REMODEL MULTIFAMILY SIGN REQ'D PROVIDED
GRADING FENCE I - I
11 REPAIR CYOS X FT.) REMARKS
1:1 DEMOLISH TANK OTHER
3 GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT El ROCKERY FUE ALARM
(TYPE OF USE. BUSINESS ORACTIVI )EXPLAIN:
TYPEMCONSTRU TION Cob OCCUPANT
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NUMBER NUMBER OF 0M 14R �10
OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
STORIES d' UNITS REQUIRED 13YES LOAD
DESCRIBE WORK TO BE DONE
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GEOTECH REPORT
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UbFEE Description FEE
Plan Check State Surcharge
HEAT SOURCE LOTSLOPE% VESTED DATE Building Permit City Surcharge
PLAN CHECK NO: Plumbing Base Fee
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Mechanical �'� /"N/)
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC Grading
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
u
PERMIT LiMIT.SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
n Fire Review Plan Chk. Deposit
n *APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
Ll
J IN INTEREST, AGREES -TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
E EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt N
r ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
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* 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 Amt. Due 4od
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee Receipt N
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 Thn, application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC. CALL Building 011icial or hisihot Deputy and Fees are paid. and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED rorelpt ffiacknowlinIg id in space provided.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S coMPEN s5pqt�U RANCE AND RCW 18:27.
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W AL. SIGNA U F DATE
SftNATURE (OWNE GENT): DATESIGNED (425) cv, k-S-105
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VA 71-0220
ATTENtjbN IXT. 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 / IBC1110 I IRC110. PINK -OWNER - GOLD - ASSESSOR
10/04 PRESS HARD - YOU ARE MAKING 4 COPIES
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