20050903.pdf7CEIVED
PERMIT EXPIRES
PERMIT
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION AJooRE55 SUITEIAPT#
OWNER NAMEINAME OF BUSINESS l ♦.. /.� �,,, r. �; r'� 1? �� :— L /'
�• ((� t ' <tREQUIRED
SUBDIVISION NO. LOT NO, LID NO.
*MAILINGADDRESS LID FEE S
T OF WAY PER OFFICIAL STREET MAP tESCPApproved
13
� /� RW Permit Required 0
Street use Permit Required
CITY ZIP TELEPHONE PROPOSED inspection Required O
Sidewalk Required l7
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/ 1�! EDICATION FT Wem Oro used 171" L i t JNAME E LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES 13 NOO z
swADDRESS zNTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE E5
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CITY ZIP ITELEPHONE
ADDRESS
CITY
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NEW
❑
ADDITION
REMODEL
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REPAIR
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DEMOLISH
❑GARAGE
CARPORT
(TYPE OF USE, B
ENGINEERING REVIEWED BY
DATE
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11 FIRE REVIEWED BY DATE w Z
ZIP TELEPHONE ce 0
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EXPIRATION DATE CHECKED BY VARIANCE OR CU SHORELINE OR B# INSPECTION SEPA I m
REO'DCOldPLETED EXE I
OHI Im A? O YES AND
'ARCEL NO. CA ZONE SIGN AREA I HEIGHT ` i1
' WAIVER C1 ALLOW D PROPOSED ALLOWED PROPOSED
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STUDY o --�- �-1 Z v m
❑ RESIDENTIAL ❑ PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) C1T1 O
�/ ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR t7 O
COMMERCIAL COMPLIANCE OR Z 0 C
❑ CHANGE OF USE � �z C
❑ KMIXED USE PARKING LOT AREA PLANNING REVIEWED BY DATE g = M
❑ MULTIFAMILY SGN REO'D PROVIDED
❑GRADING FENCE ) �
CYDS ❑ ( X FT.) REMARKS D Z
El TANK ❑ OTHER w r
RETAINING WALL FIRE SPRINKLER d O! �► N
❑ ROCKERY ❑ FIRE ALARM r a' / _. S j, ^/. i mn T
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O S UC ON GROUPANT _
NUMBER OF m M
OCCUPANT O
OF DWELLING SPECIAL INSPECTION CONSULTANT (n
STORIES UNITS LOAD n lr
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REQUIRED ,YES
DESCRIBE WORK TO BED NE m
REMARKS t7
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1 9 c("t `J H ts rf�r GEOTECH REPORT m r
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Description FEE Description FEE 0)
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Plan Check _ State Surcharge O
HEAT SOURCE LOT SLOPE% VESTED DATE
Building Permit City Surcharge m
PLAN CHECK NO: Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO MDChanICBI
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)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Deposit
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Plan i
Revew an .
'APPLICANT, ON BEHALF bF-HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire p
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 #
I HEREBY ACKNOWLEDGE THAT 1 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 his/her Deputy: and Foes are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED receipt is acknowledged in space provided.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S NSATION INSURANCE AND RCW 18:27. OFFIC�L
51GNAT E(0WyL OR NT): DATE SIGNED (425)
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771m0220 -0220 RELEASED BY TE�
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- ORIGINAL -FILE YELLOW -INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110. PINK -OWNER GOLD - ASSESSOR'
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