20050837.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NA
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OFFF BUSINESS
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CITY ZIP TELEPHONE
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ADDRESS
[PERMIT EXPIRES-
PERMIT
NUMBER%c ice„
JOB SUITEIAPT#
ADDRESS
PLAT NAME/SUBDIVISION NO. LOT NO , LID i O
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApprovea O
RW Permit Requited 0
Street use Permit Requued E3
EXISTING PROPOSED _ Inspection Requited O
Sid"*^ Required 0
REQUIRED DEDICATION FT Underyrund O
-- Wiling required O
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES13 N013 z
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REMARKS W
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE z
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NAMErr�__ CBLL## /
J►1i" cK r I ENGINEERING REVIEWED BY DATE
cc ADDRESS
FIRE REVIEWED 8Y DATE. W
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STATE LICENSE NUMBER PI TION DATE CHECKEDABY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
c�.,�! ` REO'D COMPLETED EXEMPT
CWOAV O DYES NO
PROPERTY TAX ACCOUNT PARCEL NO. CA# ZONE SIGN AREA HEIGHT
Q WAIVER C3 ALLOWED PROPOSED ALLOWED PROPOSED
W
J / STUDY D
NEW ❑ RESIDENTIAL❑ PLUMBING I MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR t7
COMMERCIAL COMPLIANCE OR
❑ ADDITION ❑ CHANGE OF USE _
❑ MIXED USE PARKING LOT AREA PLANNING REVIEWED BY DATE g
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REO'D PROVIDED
❑❑ GRADING ❑ FENCE X FT.) REMARKS
REPAIR CYDS
❑ DEMOLISH ❑ TANK �Ia Vft^I0lS
GARAGE Z ❑ CARPORT ❑ RETAINING ROCKERY WALL FIRE ❑ FIRE ALARM LER
a(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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TYPE OF CONSTRUCTION CODE GROUPANT
wNUMBER NUMBER OF
pFDWELLING/ SPECIAL INSPECTION CONSULTANT OCCUPANT
STORIES UNITS - LOAD
0 REQUIRED 13 YES
DESCRIBE WORK TO BE DONE
REMARKS t7
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GEOTECH REPORT m
BY:
I V " STRUCTURAL DESIGN
pity 1� BY:
PIfp �") VvJ VALUATION
a% $
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE�7 LOT SLOPE% VESTED DATE 1 �-
Building Permit City Surcharge Ate
PLAN CHECK NO: C �, r Plumbing Base Fee
I ,
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC Gradin
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g
t SEPARATE PERMISSION.
Engr. Review
W PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
a PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engf: (nSpeC110n
"APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review l" J '" Plan Chk. Deposit
Uj IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 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 L
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape insp. Total Amt. Due /. %z
= NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee Receipt # ✓ f�. L
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 This application Is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• CALL Building Official or hislhor 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 FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S CO INSURANCE AND RCW 16:27. OFC NAT DATE
SIGNAI; DATE SgIG EO (425)
J J�' 771 =0220 R QASED 8Y D E
ATTENTION ''''1
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL EXT. 1333 ; ; M}� ' �� �„ �f ����,
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-' ORIGINAL FILE YELLOW -IN PECT
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 I IBC110 I IRC110. PINK -OWNER • GOLD - ASSESS()
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