20050908.pdfDATE RECEIVED
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CITY OF EDIIAONDS Nu BIER ��z9 jVo'5
CONSTRUCTION PERMIT APPLICATION JAOB
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OWNER NAME/NAME OaF,BUSINESS
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ii I t4 e PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
MAILINGADDRESS �/ Y• Y//1� LIDF S -
(/ 2 / � �/� 2v N 02 (�7�, PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Pomil tt Approved
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- • Street Use Permit Required E3
CITY ZIP TELEPHONE EXISTING PROPOSED
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NAME CBL#
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CITY ZIP+ f TEELLE�P,H/ONE FIR REVIEWEDBY� I,ASer }I`�DI ls? a 4S.tE•w EJRA ii.i.CAL
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STATE LICENSE NUMBER EXPIRATION PATE CHECKED BY R +
COMPLETED EXEMPT
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CA# ZONE SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. WAIVER13 ALLOWED PROPOSED ALLOWED PROPOSED
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C] NEW ESIDENTIAL UMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR c7
COMMERCIAL COMPLIANCE OR z
❑ ADDITION ❑ CHANGE OF USE z
❑ MIXED USE PARKING LOT AREA PLANNING REVIEWED BY DATE 5
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REQ'D PROVIDED
❑ REPAIR T1CYDS
GRADING ❑ (ENCS X FT.) REMARKS
❑ DEMOLISH ❑ TANK ❑ OTHER
GARAGE ❑ RETAINING WALL ❑ FIRE SPRINKLER
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❑ CARPORT ROCKERY FIRE ALARM
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TYP OF CONSTRUCTION C OCCUPANT
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GNUMBER NUMBS OF
OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
O STORIES UNITS LOAD
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DESCRIBE WORK TO BE DONE
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4 VALUATION
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Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE
Building Permit City Surcharge
PLAN CHECK NO: Plumbing Base Fee v�
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
SEPARATE PERMISSION,
Engr. Review
oic 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
'
APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
ST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
S FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL.NOT BEO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE LandscapeInsp. Total Amt. Due
IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee Receipt #
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 isnot a permit until signed by the
THE OWNER, 1 AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building Official or his/her Deputy: and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED FOR INSPECTION receipt is acknowledged in space provided.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 15:27. e�C FF IALS SIGN E DATE
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E Q GENT)- DATE SIGNED (425) i l
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!,� , r4aeoo ° •7- E� J 771-0220 LES BY f �D
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- ORIGINAL FILE YELLOW -INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1091 IBC1101 IRC110. PINK -OWNER GOLD ASSESSOR .
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