20050886.pdfa
DATE RECEIVED
J PERMIT EXPIRES
CITY OF EDMONDS NUMBER ") 12,
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CONSTRUCTION PERMIT APPLICATION
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OWNE NAMEINAME gE.ISINESS
'r / /wry PLAT NAME/SUBDIVISION NO. LOT NO LID NO.
MAILING ADDRESS w
LID FEE $
O ` f r V PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP qw Permit Required O
Street use Permit Required 0
CITY ZIP TELEPHONE EXISTING PROPOSED Inspection Required 0
SMewae l 0 REQUIRED DEDICATION FT underground 0
Wmn required
urtod 0
NAME 1. /J�� d � METER SIZE LINE SIZE ft[-w7NO, OF FIXTURES PRV REQUIRED
UftLllJ/wV T YES 0 NO O
t ADDRESS REMARKS w
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE _
CITY ZIP TELEPHONE
NAME CBL#
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��L/�•-� �719A I
¢ ENGINEERING REVIEWED BY DATE
AD(/DRESS // ���,✓ c
FIRE REVIEWED BY DATE w
CITY ZIP TELEPHONE
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STATE LICENSE NUMBER EXPIRATI DATE gy VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
REQ'D COMPLETED EXEMPT
Vbq� 0 YES ONO
CA# ZONE SIGN AREA HEIGHT
PROPERTY TAXA COUNT PARCEL NO.
WAIVER C3 - ALLOWED PROPOSED ALLOWED PROPOSED
3n0 STUDY O
❑ NEW RESIDENTIAL ❑ PLUMBING 1 MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
E] COMMERCIAL COMPLIANCE OR z
❑ ADDITION ❑ CHANGE OF USE _
❑ MIXED USE PARKINGLOT AREA PLANNING REVIEWED BY DATE g
REMODEL El MULTIFAMILY ❑ SIGN REQ'D PROVIDED
1:1 REPAIR El GRADING CYDS ❑ FENCE X FT.) REMARKS
❑ .DEMOLISH ❑ TANK ❑ OTHER
FIRE
❑ CARPORT ❑ ROCKERY GARAGE RETAININGWALL ❑ FIRE ALA MKLER .
(TYPE OF USE, BUSINESS OR ACTIVITY) EX IN:
�G%�' TYP TRUCTION OCCUPANT
GROUP
NUMBER �?� NUMBER OF
OF � -�V�� DWELLING SPECIAL INSPECTION CONSULTANT OCCU T
p STORIES UNITSLOAD
REQUIRED O YES
DESCRIBE WORK TO BE DONE
REMARKS O
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GEOTECH REPORT ` m
- - n BY:
STRUCTURAL DESIGN
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x� VALUATION OF
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C % / Description FEE Description FEE
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Plan Check State Surcharge
HEAT SOURCE LOT SLOPE% "J�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
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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC Gradin
E DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g
SEPARATE PERMISSION. Engf. R@VIEW
w PERMIT APPLICATION: SEE ECDC 19.03.005(A)(5)
a PERMIT. LIMIT: SEE ECDC 19,00.005(A)(6) Engr. Inspection
BACK OF PINK PERMIT FOR MORE INFORMATION
in •APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
w 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 #
_ 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 /t
= NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION,*
Recording Fee Receipt #
1 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
[IN
HE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• CALL Budding Official or his/her Deputy: and Foos aro paid, and
ION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
VI L Oft OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION recoipl is acknowledged in space pmwdod
O N' COMPENSATI RANCE AND RCW 16:27FFI S SIGNATt f DAT .I ER OR GENT): DATE GNED (425) ��
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771-0220, R E SED BV '6
ATTENTION EXT. 1333 n '
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL Far YC1l OW ser Oli
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109I IBC110I IRC110. PINK-OWNC11 . GOLD • ASSESSOR
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