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RECEIVED O
if U , PERMIT EXPIRES /I
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB ooREss/ SUITE/APT#
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1 1' I � CC�� PLAT 14AMEISUBDIVISION NO. LOT NO. LID NO.
l� L 7
Lx MAILING ADDRESS LID FEE $
Lx
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p -y •�' PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP 7ESCPApproved
L ❑
p C EX% / r - RW Permit Required ❑
Street Use Permit Required ❑
CITY \ ZIPP� TELEPHON P11`000 / EXISTING _ PROPOSED inspection Rugwed 13r
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NAME METER SIZ7 LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES O NO O z
W w
t ADDRESS REMARKS W
u OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
z
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CITY ZIP TELEPHONE 1
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EIJGINEERING REVIEW.NOTI7� ya t� DATE
ADDRESS
7-4* '114d"UPTED
�¢ FIRE REVIEWED BY DATE UJI
Z CITY ZIP TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE CHE E B VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA i 0
REQ'D COMPLETKP EXEMPT,
YES IJO t' 0
Q PROPERTY TAX ACCOUNT PARCEL NQ,. CA# L$Q .� f� r rml � Ht to
�r�/,�� / _ �/'�n I M WAIVER I3 �t a Ai�OW ROP E4 ALLOWED F>OPOSED
�i1111JJ11 IIYn l�-/YL J\ L/�� �0 STUDY 13 ►7 to D.i:D0f1L t 's r 1 ,�.•TI
❑ NEW RESIDENTIAL j PLUMBING 1 MECH LOT CQ GES •�uREpSETBACKS"(F � KS (FT.) � (n
ALLOWED PROPOSED FRONT SIDE REARFRONT UR SIDE REAR 0 v rn
❑ COMMERCIAL COMPLIANCE OR i C
❑ ADDITION E] MIXED USE a CHANGE OF USE z M
PARKING LOT AREA PU>NNING REVIEWED BY DATE g O 0
E] REMODEL 13 MULTIFAMILY El SIGN REQ'D PROVIDED C
GRADING FENCE
❑ REPAIR 13CYDS ❑ ( X FT.) REMARKS m Z
11 DEMOLISH DEMOLISH ❑ TANK ❑ C �
_ ❑GARAGE RETAINING WALL FIRE SPRINKLER Z
CARPORT ❑ ROCKERY ❑ FIREALARM r—
a(TYPE OF USE, BUSINESS OR ACTIVI Y) EXP IN: t
FE ' TYPE OF ST U T ON COpE, JOCCUPAr{?'%
U U GROUP /Y�,`. � it
suNUMBER NUMBER OF I
OF DWELLING 1 SPECIAL INSPECTION CONSULTANT OCCUPANT -�
p STORIES - UNITS ((( LOAD X'
-r REQUIRED 0 YES M M
DESCRIBE WORK TO BE DONE
REMARKS i O 0)
a) &A- TUI NA£E CLA776A) C �
GEOTECH REPORT
BY: m
STRUCTURAL DESIGN t Z n
BY:
Lly)t VALUATION ;U
$ _
O P 'N� n
Description FEE Description FEE ,) 2
Plan Check State Surcharge t _
HEAT SOURCE LOT SLOPE% VESTED DATE
Building Permit City Surcharge Z
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PLAN CHECK NO: Plumbing Base Fee
0
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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 S
l` PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
IL 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
uj 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 I
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 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•
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or acknowledged
Deputy: and Fees are paid, and
IN VIOL N O THE LAB E OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKM N'S SAT N INSU NCE AND RCW 16:27. OF I
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IG ED NE (425)A�)
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7 ! 1 -0220 RELEA E BY 1i\y �IJDATE `f
TENTION EXT. 1333 j
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. UBC169 1 IBC110 I IRC110• PINK -OWNER GOLD - ASSESSOR
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