20050932.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERM -IT APPLICATION
OWNER NAMEINAME OF BUSINESS
Quiznos Sub
MAILING ADDRESS
201 - 5th Ao. S., Edmonds
CITY ZIP 1 ELEPHONE
Edmonds 98020 425-248-0042
NAME
ADDRESS
TELEPHONE
1:2 111 Itil
PERMIT EXPIRES
PERMIT
NUMBER
JOB
ADDRESS S6lTFJAP*
201 - 5th Ave. S.
I I
PLAT NAMEISUBDIVISION NO.
LOT NO.
LID NO.
I
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
13
0
RW Permit Required
Street Use Penrid Requited
0
EXISTING PROPOSED
Inspection Required
E3
Sidewalk Required
13
REQUIRED DEDICATION FT
Underground
13
0
Wiring required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YESO NO13
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REMARKS
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OWNER)CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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NAME CBL#
MENGINEERING REVIEWED BY DATE
ADDRESS
FIRE REVIEWED BY DATE W
CITY ZIP TELEPHONE 0:
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VARIANCE OR Cu SHORELINE �R t2o INSPEICTION SEPA
STATE LICENSE NUMBER EXPIRATION DATE CHaICKED BY L4A A I I RE 0 1 COMPI ETED EXEMPT
�ROPERTY TAX ACCOUNT PARCEL NO.
00434212100100
NEW RESIDENTIAL
COMMERCIAL
ADDITION MIXED USE
El REMODEL MULTIFAMILY
REPAIR GRADING CYDS
DEMOLISH TANK
GARAGE o RETAINING WALL
CARPORT ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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13 YES ENO
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SIGN EA
HEIGHT
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WAIVER [3
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ALLOWED OSED
ALLOWED PROPOSED
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STUDY E3
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W411 W411
L U M B N G E C H
PLUMBING I MECH
P 1 M
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
ALL
FRONT SIDE REAR
FRONT L/RSIDE REAR
C M P L A C
COMPLIANCE OR
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C H A N E 0 F E
CHANGE OF USE
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PARKING
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REO'D PROVIDED
LOTAREA
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PLA14NING REVIEiWED BY DATE
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EYSIGN
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FENCE
REMARKS
REM)
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OTHER
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FIRE SPRINKLER
FIREALARM
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Fast Food Restaurant
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NUMBER
OF
STORIES
NUMBER OF
DWELLING
UNITS
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SPECIAL INSPECTION
REQUIRED 0 YES
DESCRIBE wnRK Tr) RF nnNF z
REMARKS
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
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VALUATION
$ 2, olo. bo
Description
Plan Check
HEAT SOURCE
LOT SLOPE%
ESTED DATE
Building Permit
PLAN.CHECK NO:
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION..
Grading
Engr. Review
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
Engr. Inspection
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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
NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION.0
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
I 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
OCCUPANT
GROUP
CONSULTANT OCCUPANT
I LOAD
FEE Description FEE
el 4 State Surcharge
City Surcharge
Base Fee
THE OWNER. I AGREE TO COMPLY WITH CITY AND STAI E LAWS REGULATING CONSTRUC
CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYE
To
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IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING T FOR INSPECTION
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
S71GN W IT,, DATE SIGNED (425)
771-0220 R
ATTEWFION 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 / IBC110 if IRC110.
110104 . I PRESS HARD - YOU ARE MAKING 4 COPI
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
FI�CIALS SIGNfURE DATE
M1112101t
BY foATj/,r
ORIGINAL . L - YELLOW -INSPECTOR
PINK - OW R - GOLD - ASSESSOR
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