20051044.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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NAME
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STATE LICENSE NUMBER XPIRA ION DATE CHECKED BY
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PROPERTY TAY. ACCOUNT PARCEL NO.
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NEW ❑ RESIDENTIAL .AMIIIIMgGMECH
COMMERCIAL COMPLIANCE OR
❑ Me
ADDITION ❑
❑ MIXED USE CHANGE OF USE
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN
❑ REPAIR 1:1CYDS.
GRADING ❑ FENCE X FT.)
❑ DEMOLISH ❑ TANK 9f WAgyo
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❑GARAGERETAINING WALL FIRE SPRINKLER
CARPORT ❑ ROCKERY ❑ FIREALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: t
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PERMIT EXPIRES
PERMIT I
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NUMBER �70J- JOB 4(L/
ADDRESS h ' tr� �� S TEI.APT# IDS —t` k:I
PIAT NAMEISUBDIVISION NO. LOQLID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP tESCPApproved, O
RW Permit Regwrod
Street Use Pl=i Raquded ❑
EXISTINGi PROPOSED Inspection Required O
Sidewalk Required 0
REQUIRED DEDICATION FT._ Underground O
Wiring re ueed O
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES CI NO 13 Z
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W
REMARKS i
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE w I
VARIANCE OR CU SHORELINE OR ADB# INSPECTION I SEPA J
REO'D COMPLETED EXEMPT
i3 YES II! NOI I V .
CA# ZONE SIGN AREA HEIGHT
WAIVER 13/' ALLOWED PROPOSED ALLOWED PROPOSED
STUDY 13 �/ C71 35 G ?25
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR c7
151 IND CoWMLIE
PARKING LOTAREA PLANNING REVIEWED BY 1'D—ATE 5
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CCPANT
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GNUMBER NUMBER OF
OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
O STORIES \ UNITS LOAD
DE CRIBE WORK TO BE DONE REQUIRED YES
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GEOTECH REPORT pi i i 0
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pjf'ci V vO STRUCTURAL DESIGN
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VALUATION
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Description FEE Description FEE
f V Plan Check / State Surcharge 4 '
HEAT SOURCE LOT SLOPE% VESTED DATE
Building Permit LI City Surcharge
.PLAN CHECK NO:
Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOT D. THIS PERMIT COVERS WORK TO MOChanICBI
I_ BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
2. OONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading.
I= SEPARATE PERMISSION.
X Engr. Review
w PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
a 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 Review Plan Chk. Deposit
Lu IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
i 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. Duejq
= NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION,* r
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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• CALL This application is not a permit until signed the
TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or Deputy: and Fees are p pard, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
OFFICIAfS SIGYATURE j DATE
PATENTION
ER O DATE SIGNED (425) I it
top, e/ �� 771.=1.1220 ` ELEASJB) DTE
EXT. 1333 j� l
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, UBC1091 IBC110 I IRC110, o NNAL -FILE E OW -INSPECTOR
PIl K -OWNER D -ASSESSOR
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