20051017.pdfDATE RECEIVED
0--a-015 I 1PERMIT EXPIRES 9-2-660
PERMIT
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB Cf
ADDRESS _"ZlTqAPTH
AME/NA E OF BUSINESS / 7 61 11 c/i 73 1/
PLAT NAMEISUBDIVISION NO, LOT NO LID NO
Ui MAILINGADDRESS LID FEE S
�;;;I J P I �' ) PUBLIC RIGI IT OF WAY PER OFFICIAL STREET MAP TESCP Approved [3
0 RW Permit Required 13
Street Use Permit Required 13
CITY ZIP TELEPHONE EXISTING PROPOSED— Inspection Required 0
:—e-? I ,% Sidewalk Required E3
0 REQUIRED DEDICATION FT . U . n - defg - r - ound E3
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NAME METER SIZE.. L!NE.S!i FIXTU�E�j RV REQUIRED
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CITY ZIP TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE DBY VARIANCE OR CU SHORELIN ON SEPA
PT P OTO COMPLETED I EXEMPT
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CA# ZONE SIGN AREA HEIGHT
-j PROPERTY TAX ACCOUNT PARCEL NO.
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STUDY 13
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D NEW, RESIDENTIAL P L&ND; /6DEH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR
COMMERCIAL COMPLIANCE OR z
ADDITION CHANGE OF USE I I i
MIXED USE PARKING LOT AREA PLANNING REVIEWED BY DATE
REMODEL MULTIFAMILY SIGN REO'D I PROVIDED
GRADING FENCE
REPAIR CYDS X FT.) REMARKS
DEMOLISH TANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIREALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
J- CODE OCCUPANT
1� GRO
NUMBER NUMBER OF
OF DWELLING TI N CONSULTANf OCCUPANT
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0 STORIES UNITS LOAD
3 — ___7 --- I I REQUIRED YES
DESCRIBE WORK TO BE DONE
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occz-A oll - _,0 v-�j 166(, h,!�,r Description FEE Description FEE
.)4 �w ellgil he. State Surcharge
HEAT SOURCE LOT9LOPI!% VESr D DATE Building Permit City Surcharge IS
PLAF4 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 Grading
DONMAIN [CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
W
PERMIT LIMIT. SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
to Fire Review Plan Chk. Deposit
U) APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
Ui 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
o
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. Recording Be 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 permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building Official or his/her Deputy: and Fees are paid. and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowled d in space provided
WORKMEN'S COMPENSATIO ND RCW 18:27.
'�RANCIE A O\1CI SIG JRE DATE
SIGNAT wNZE kAG NT): DATESIGNED
VRE(O �01-1- 5X 146i' / / // L I—? �Az;
-at4a TA 771-0220 R DATE
(425)
&TgNTION EXT. 1.333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL L
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI ORIGINAL -FILE - YELLOW -CTO!) L
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110. PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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