20051062.pdfDATE RECEIVED
Q Z D PERMIT EXPIRESfoo
PERMIT
CITY OF EDMONDS NUMBER TZ 106
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
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OWNER NAME/NAMEADDRESS JOF BUSINESS
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
MAILING ADDRESS LID FEE 5
I e I PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved ❑
ELLY • RW Permil Required E3ZIP TELEPHONE EXISTING PROPOSED Street Use Permit Required ❑
^ _ Inspection Required p
I✓ iJ {_, I r r 1 - Sidewalk Required [3p
t {/ REQUIRED DEDICATION FT underground
Wiring required p
VAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES O NO O z
ADDRESS
REMARKS. W
W
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE z
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CITY ZIP TFt Faunua Dj�/1 I JA ) f. r r a r _ — n . /_ d% ft W
NAME C L# / - Nz A L TO 13 F COA4,81 " ED
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EN EERING REVIEWED BY DATE
(K ADDRESS
FIRE REVIEWED BY
CITY ZIP TELEPHONE DATE W
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STATE LICENSE NUMBER EXPIRATION DATE C ECKED Y VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
�4>9 /� �y[_--7 .7�G� ��' /O @ ES E COMPLETED EXEMPT
�` 4 ( OYES 1� NO
a PROPERTY TAX ACCOUNT PARCEL NO.31 CA# ZONE SIGN AREA HEIGHT
O�/'� WAIVER ID ALLOWED PROPOSED ALLOWED PROPOSED Cot
y�y v STUDY O
($ NEWRESIDENTIAL ❑ PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
T ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR
❑ ADDITION . ❑ COMMERCIAL COMPLIANCE OR z
❑ MIXED USE ❑ CHANGE OF USE z
❑ REMODEL❑ MULTIFAMILY ❑ SIGN REQ'D ARPIROVIDED NG LOTAREA PLANNING REVIEWED BY DATE06
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❑ REPAIR ❑ GRADING FENCE
CYDS ❑ ( X FT,) REMARKS
13DEMOLISH ❑ TANK ❑ OTHER
z ❑GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ❑ ROCKERY FIREALARM
0
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: �+
TAPE OF COjJSCTION C DFS OCCUPANT
C NUMBER NUMB % '`v` GROUPER OF i�w{ G
OOF DWELLING / SPECIAL INSPECTION CONSULTANT OCCUPANT
STORIES UNITS LOAD
DESCRIBE WORK TO BE DONE REQUIRED 13YES
REMARKS
GEOTECH REPORT
BY: m
N G,~ F—�4. Q W t/ STRUCTURAL DESIGN
BY:
VALUATION
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Description FEE Description FEE
Plan Check Slate Surcharge , 5o
HEAT SOURCE LOT SLOPE% VESTED DATE
Building Permit f City Surcharge
PLAN CHECK NO:
Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
It: SEPARATE PERMISSION.
xEngr. Review
W PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
IL 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 Fire Review O Plan Chk, Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection` Recei t # / Sig
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY p
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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.•
ON Recording Fee Receipt # 1 '
GIVEN IBS CORRECT` AND TTHAT EDGE TI AM THE OWNER, OR THE DULY AUTHORIZED AGENT I HAVE READ THIS APPLICATION; THAT THE IOF APPLICATION APPROVAL
THE OWNER. 1 AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or hislher Deputy: and Fees are paid, 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
FFI LS SIGN A RE DTE
SIGNAT RE (O R O GEN DATE SIGNED (425)
0/2g 1 Q 771'0220 RE A E BY
ATTENTION EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL Vk-
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109 I IBC110 I IRC110. ORIGINAL -FILE •YELLOW • AP
PINK • OWNER GOLD ASSESSOR
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