20050816A.pdf7RE7
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CITY OF EDMONDS Nu BER c9w Is — g/
CONSTRUCTION PERMIT APPLICATION ADDRESS L. ' SUITE/APTp
OWNER N I AME OF BUSINESS(0 Gun
'5 Zr't ter• "/ 6/" e f PAT NAME/SUBDIVISION NO. LOT NO. LID NO.
MAILING ADDRESS
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved ❑
RW Permit Requnod ❑
Street Use Permd Requeed ❑
CITYZIP TELEPHONE EXISTING __ PROPOSED E3_ Inspection Required
- - Sidewalk Required ❑
�v •C r• �( Under round ❑
✓ REQUIRED DEDICATION FT q
[Wifina required ❑
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES 13 NO O z
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ADDRESS REMARKS z
OWNERlCONTRACTOR RESPO I E FOR EROSION CONTROL/DRAINAGE z
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NAME ++ CBLtt
ADDRESS
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CIT ZIP TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE C Y
16�
PROPERT T AC OUNT PARCEL N0.
�/4 0 3io
❑ NEW ❑ RESIDENTIAL ❑ PLUMBING / M H
COMMERCIAL COMPLIANCE OR
❑ ADDITION ❑
MIXED USE CHANGE OF USE
❑
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN
y�REPAIR. GRADING FENCE
WI ❑ CYDS ❑ ( X FT.)
❑ DEMOLISH ❑ TANK ❑ OTHER
❑GARAGE RETAINING FIRE
CARPORT ❑ ROCKERY WALL ❑ FIRE A ARhKLER
BY DATE
FIRE REVIEWED BY
DATE
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VARIANCE OR CU
SHORELINE OR ADBtt INSPRECTION
SEPA
EQ'D
COMPLETED EXEMPT
i] YES i7 NO
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ZONE
SIGN AREA
HEIGHT
W IVER 13
ALLOWED .PROPOSED
ALLOWED PROPOSED
S UDY O
001. LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT L/R SIDE . REAR
z
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PARKING
LOTAREA
PLANNING REVIEWED BY DATE
S
REQ'D , PROVIDED
TYPE OFT CTION C OCCUPANT
13GROUP
o .NUMBER NUMBER OF
m OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
0 STORIES C72 UNITS LOAD
DESCRIBE WORK TQ BE DONE REQUIRE YES
e OAJ Gc/ep, / ` REMA
d /✓ e "`„ GEOTE H REPO ,
I BY:
( f0bTSTRUCTURAL DESIGIST
BY:
odi)cL (my !vb VALUATION
$�
y' Description FEE Description FEE
Plan Check q1 Slate Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE
Building Permit City Surcharge
PLAN CHECK NO: Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
rY PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5) Engr. Review
a PERMIT LIMIT: SEE ECDC 19.00,005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
y 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
uj 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 #
a ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
= FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE T
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due LI
= NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' r
Recording Fee Receipt # P
6EN
KNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
RRECT; AND THAT I AM OWNER, OR THE DULY AUTHORIZED AGENT OF
I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• CALL This application Is riot a permit until signed by the
DOING THE A HORIZED THEREBY; NO PERSON WILL BE EMPLOYED Building Official or hls/herlDeputy: and Fees are paid, and
N THE OR CO E OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged In space provided.
N INSU ANCE AND HCW 18:27.
OF IGH E DAT
O AGE DATE IGNE (425)
C
y 771 "0220 LEAS D ATE
ATTENTION 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. UBC109 / IBC110 / IRC110. INK • OAL - lii LLOLD
- ^IN PECTO
PINK ER ASSESSOR
10104 PRESS FEAR® = YOU ARE MAKING 4 COPIES P
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