20050891.pdf40.1
DATE RECEIVED
e CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS /n!/] G//%n`��1
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CITY ZIP TELEPHONE
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PERMIT EXPIRES D
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PERMIT 67
JOBNUMBER C%�k�'�•�� 0 /
JOB SUIT' PT#.
ADDRESS?..
PLAT NAM EISUBDIVISION NO. LOT NO. LID NO,
LID FEE 5
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved 13
RW Permit Required C
Street Use Permit Requited L3
EXISTING' PROPOSED Inspocaon Required E3
/Sidewalk Required 13
REQUIRED DEDICATION FT Underground O
Wmn r w+od 17
METER S1ZE LINE SIZES NO. OF FIXTURES PRV REQUIRED
/ �✓ YES O NO O z
REMARKS tu
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OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROIJDRAINAQE z
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EVIEWED BY DATE
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�--- VARIANCE OR Cu SHORELINE OR ADB# INSPECTION SEPA
STATE LICENSE NUMBER EXPIRATtnki ^"Tr -• • �•.cn nv
REQ'D COMPLETED E%EA1�
/ � OYES NO
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PROPERTY TAX ACCOUNT PARCEL NO.
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ZONE SIGN AREA HEIGHT
J i ST IVER O '[Z �° 000 _ ALLOWED�� ,� ALLOWEDPROPOSED
❑ NEW ❑ RESIDENTIAL ❑ PLUMBING ! MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED kTBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
�Q COMMERCIAL COMPLIANCE OR
❑ ADDITION rf"'o ❑ CHANGE OF USE
❑ MIXED USE
❑ REMODEL ❑PARKING LOT AREA PLANNING REVIEWED BY DATE
MULTIFAMILY GN REQ'D PROVIDED )A `r
❑ REPAIR ❑ GRADING CYDS
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NCE7 4J
( X FT.) REMARKS
❑ DEMOLISH ❑ TANK ❑ OTHER
❑ CARPORT ❑ ROCKERY RAGE RETAINING WALL ❑ FIREALARM FIRE LER
(TYPE OF USE, BUSINES5oqR ACTIVITY) EXPLAIN:
TYJ OF C�Ot�S RU TION DE
GROUP
NUMBER L - NUMBER OF C�wJL/(/J�^
OF DWELLING /1 I SPECIAL INSPECTION CONSULTANT OCC ANT
STORIES UNITS / V` LOAD,
REQUIRED 0 YES
DESCRIBE WORK TO BE DONE
REMARKS
GEOTECH REPORT'
BY:
STRUCTURAL DESIGN
BY:
VALUATION
$
Description FEE Description FEE
Plan Check " Stale Surcharge
HEAT SOURCE LOT SLOPE%a VESTED DATE J
Building Permit `— City Surcharge C
PLAN CHECK NO: - �� Plumbing Base.Fee
D5 625
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
E DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
u PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engf. Inspection
•APPLICANT, ON BEHALF OF NIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk: Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee. Receipt # y i
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• CALLBuilding Official or his/her Deputy: and Fees are paid. and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLA N OF THE LABOR E OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged In space provided.
WO N'S CO ENS T N IN NCE AND C 8:27. FFI S SIGNATOR DTE
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ATTENTION EXT. 1333�0
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL�
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- 0GINAL -FILE LLOW .INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1091 IBC110 I IRC110. INK OWNER G LD • ASSESSOR
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