20051015 (2).pdfPERMIT EXPIRES OZ
CITY OF EDMONDS PERMIT
NUMBER
CONSTRUCTION PERMIT APPLICATION jol SUITEIAPT#
ADDRESS i��//� �/j�[�%• 2[
OWN/EiR� NAMEI[NAME B SINE/SS//' �}/J ,t�
�. !1 V let /• �, Vi PLAT NAME iSUBDIVISION NO LOT NO LID NO.
w WILING A DRESS
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PUBLIC RIGHT OF WAY �(.J��jj�l{.1A1.a7EiEL1.l.WP._ . ._....�..., ICSCEA�w ❑
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UOWNEWCONTRACII(fl ?OI�$0114 FOR EROSION CONTROUDRAINAGE
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CITY ZIP ITELEPHONE
NAME % CBL#
ENGINEERING REVIEWED BY DATE
ADDRESS
FIRE REVIEWED BY DATE
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CI ZIP TELEPHONE �
STATE LICENSE NUMBER EXPIRATION DATE NEC DEI VARIANCE OR CU I SHORELINE OR ADB# INSPECTION SEPA
�� REO'D COMPLETED EXEMPT
J4 �/_"' y �ll �!� O YES ONO
PROPERTYTAXACCOUNT,ARCELIJO. CA# _ ZONE SIGN AREA HEIGHT
^ %�}�`� WAIVER i' ALLOWED PROPOSED ALLOWED PROPOSED
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RESIDENTIAL LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
❑ NEW PLUMBING { MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR r,
❑ COMMERCIAL COMPLIANCE OR i
❑ ADDITION ❑ MIXED USE CHANGE OF USE ¢
PARKING LOT AREA PLANNING REVIEWED BY DATE S
❑. REMODEL ❑ MULTIFAMILY ❑ SIGN REQ'D PROVIDED
❑❑ GRADING ❑ FENCE
REPAIRX FT.) REMARKS
CYDS
❑ DEMOLISH ❑ TANK ❑ OTHER
_ ❑ CARPGE RETAINING WALL LER
ORT ❑ ROCKERY ❑ FIREALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
R j� OA(ST T N C DE OCCUPANT
U ` ri
1V) III��� GROUP
U) NUMBER. NUMBER OF
OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
O STORIES UNITS LOAD
REQUIRED LiiJ YES
DESCRIBE WORK TO BE DONE
REMARKS r,
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L 7 !` GEOTECH REPORT m
BY:
r��t�ttr STRUCTURAL DESIGN
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7 c_ / VALUATION
LC'0 �lL $
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURLOT 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
t= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
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SEPARATE PERMISSION, Engf. REVIeW
W PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
d 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 RBVIBW Plan Chk. Deposit
UJI 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 Landscape InSp. Total Amt. Due
NOR LIMIT IN ANYWAY 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 is not a pound anti! sglnod by ihu
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building Official or his/her Du ul and Foos :uo pad and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED 9 p y
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowlddynd in sp;rr.0 pmvidwf
WORKMEN'S COMPENSATIO NSURANCE AND RCW 18:27.
OFFICI RE DAT F.
SIGNAT E (OWNER E DAT SIGN)%D`� (425) �'\ Q'
�t ` / �/ • / -� 771 -0220 RELEASED BY DATED'
A#EWTION EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL t ;7? V�
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIM ORIGINAL -FILE YELLOW • INSP CTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1091 IBC110I IRC110. PINK -OWNER GOLD - ASSESSOR
10{04 PRESS HARD - YOU ARE MAKING 4 COPIES
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