20050922.pdfECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF B S
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CITY ZIP TELEPHONE
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STATE LICENSE NUMBER LXPIRATYION ATE
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PROPERTY TAX ACCOUNT PARCEL NO
NEW
ADDITION
REMODEL
REPAIR
10
DEMOLISH
r-1 GARAGE
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PI (TYPE OF USE. 13
Vb`5 1PERMIT EXPIRES
PERMIT
NUMBER
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PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved
RW Permit Required
EXISTING PROPOSED Street Use Permit Required C1
inspection Required 13
Sidewalk Required 13
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REQUIRED DEDICATION FT Underground 13
Wiring requited
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ETER SIZE, ------;,I MNE SIZE—— �,Ncr. OF1FTFU7Ffff9" 'P0 'REC UIRED
Ilia 4ddifion t the required, YES E3 N013 13
REMARKS yAlve an apDrovea W
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OW N E R/C 0 Tm-gew 1k; OSIOA RJJALR�INAGE
ENGINEERING REVIEWED BY
DATE
1YI)c B- Or comiectors required
FIRE RE�iiwi6wi-burz,..ting,-ii)pliances
passinL4DATE
through unheated spaces. IMC 803.2
VARIANCE 0 SHORELINE OR ADB# INSPECTION SEPA
U7 REO'D COMPLETED I EXIMPT
13YES [3NO1
CA# ZONE SIGN AREA I HEIGHT
WAIVERM ALLOWED PROPOSED ALLOWED PROPOSED
STUDY 13 1 1
LUMBING / MECH
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
COMMERCIAL
/11
ALLOWED PROPOSED
FRONT SIDE REAR
1
FRONT URSIDE REAR
r-_,UPLIANCE
OR
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'MIXED
USE
CHANGE OF USE
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MULTIFAMILY
SIGN
PARKING
RELO-131 PROVIDED
LOTAREA
I LANNING REVIEWED BY DATE
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GRADING CYOS FENCE
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TANK OTHER
RETAINING WALL FIRE SPRINKLER
ROCKERY 11 FIREALARM
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NUMBER
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u[NUMBER W,
OF
STORIES SPECIAL INSPECTION CONSULTANT OCCUPANT
C LOAD
DESCRIBE WORK TO BE DONE REQUIRED 13YES
REMARKS
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
of, BY:
dzz, VALUATION
$
J Aley_czaJ Description FEE Description FEE
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Plan Check State Surcharge
HEATSOURCE LOTSLOPE% VESTED DATE Building Permit City Surcharge
PLAN CHECK NO: Plumbing Ir Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK To Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5) Engr. Review
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection
,APPLICANT, ON BEHALF OF HIS 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 Landscapelnsp. Total Amt. Due
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee Receipt # 1�7 Yj -7
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABqR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is aAawled4ed in space provided.
WORKMEN'S COMPENSA3PN4"NCE AND RCW 18:27.
0 Icil NAT R DATE
DATE SIGNYD (425) C:
SIG AT OWNE A EN
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El`�TION RELEA�
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-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 If IBC110 / IRC110.
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
ORIGINAL -FILE YELLOW -INSPECTOR
PINK -OWNER GOLD - ASSESSOR
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