20050986.pdfr DATE RECEIVED in
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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PLAT NAMEISUBDIVISION NO. (� LOT NO. J LID NO.
LID FEE $
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ENGINEERING REVIEWED BY DATE
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STATE LICENSE NUMBER EXPIRATION DATE VARIANCE OR CU SHORELINE OR ADBp INSPECTION SEPA
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�1� REQ'D COMPLETED EXEMPT
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CA# ZONE SIGN AREA. HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. T
—7 O D I I O V WAIVER 0 ALLOWED PROPOSED ALLOWED PROPOSED
STUDY 13
❑RESIDENTIAL LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
NEW C ALLOWED PROPOSED FRONT. BIDE REAR FRONT L/R SIDE REAR
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ElCOMMERCIAL COMPLIANCE R z
❑ ADDITION ❑ CHANGE OF USE z
❑ MIXED USE PARKINGCL
LOT AREA PLANNING REVIEWED BY DATE g
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REQ'D PROVIDED
REPAIR GRADING FENCE
❑ CYDS ❑ ( X FT.) REMARKS
❑ DEMOLISH ❑ TANK ❑ OTHER
❑ GARAGE CARPORT ❑ ROCKIERY NING WALL ❑ FIRE AIRE LARM LER
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
S7; TYPE ONS U TION CO OCCUPANT fJ
i GROUP
NUMBER NUMBER OF
OFDWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
STORIES C UNITS LOAD
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DESCRIBE WORK TO BE DONE
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VALUATION
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Description FEE Description FEE
Plan Check Slate Surcharge
HEAT SO CE LOT SLOPE% VESTED DATE ✓
Building Permit City Surcharge
PLAN CHECK NO: Plumbing 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
E DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
J SEPARATE PERMISSION.
Engr. Review
L 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
V) '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
zEDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
a 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. 2
Rzzecording 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 AN ST S REGULATING CONSTRUC• CALL Building Official or his/her Deputy: and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED'THEREBY, N ERSON WILL BE EMPLOYED
IN VIOLATION OFT COD THE STATE WASHINGTON RELATING TO FOR INSPECTION
receipt is acknowledged in space provided.
WORKMEN'S ENSATIO RANCE APD RCW 1 7. OFFICIALS IGNATURE DTE
SIG URE (OWNER ORENT DATE SIGNED �' (425) %') /1
i 6 771'220 RELEASED BY DATE
(%
EXT. 1333
IT ISA L TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A F LNSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL - FILE YELLOW - INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109I IBC110 I IRC1106 PINK -OWNER o GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4.COPIES
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