20050819.pdfDATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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NAME
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MARICM rl ALLOWED PROPOSED ALLOWED PROPOSED
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REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
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COMMERCIAL
COMPLIANCE OR
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OTHER
FIRE SPRINKLER
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PROVIDED
REMARKS
)R ACTIVITY) EXPLAIN:
UCTI Nyj CODE OCCUPANT
GROUP
uj NUMBER JUMBER OF
OF )WELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
Co LOAD
0 STORIES )NITS I n I I
REQUIRED TES
DESCRIBE WORK TO BE DONE
REMARKS
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
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uh// A Description
Plan Check
6k Ra�/e�-
HEATSOURCE LOT SLO11E% VESTED DATE
Building Permit
PLA3 CHECK NO: Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDC 19,00.005(A)(5)
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PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
cn OAPPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review
cn
Lu AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
_j IN INTEREST, NTS FROM ANY AND
2 EDMONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGE Fire Inspection
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.
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
=in ------- Recording Fee
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC. CALL
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 FOR INSPECTION
WORKMEN'S COMPENS��U�RANCE AND RCW 18:27.
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S1G"N;AT7UR OWNER �A gNT DATE �GN D,
< .771-0220
FEE Description
State Surcharge
City Surcharge
r) tVA Base Fee
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
1 Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid. and
receipt is acknowleVged - in space provided.
mrim q zir A 11 1= DATE
ATT TION 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 / IRC1110.
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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