20051085.pdfCEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
(22 M nr le viC) 0e.4
Maplewood
MAIUNGADDRESS
CITY ZIP TELEPHONE
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NAME 401- 'E)efit' #I
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CITY ZIP TELEPHONE
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ADDRESS
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ZIP TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE I P.IJECKED BY
PROPERTY TAX ACCOUNT PARCEL NO,
1�3
NEW
RESIDENTIAL
PLUMBING / MECH
E]
ADDITION
COMMERCIAL
COMPLIANCE OR
MIXED USE
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
CYOS
FENCE
( x FT.)
DEMOLISH
TANK
OTHER
GARAGE
CARPORT
RETAINING WALL
FIRE SPRINKLER
ROCKERY
FIREALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER
OF
U
NUMBER OF
WE
DWELLING
STORIES
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UNITS
DESC'�I.BE WORK TOrBE DONE
J05 I [PERMIT EXPIRES L7111
PERMIT I I /
NUMBER
JOB ITE/APTH
ADDRESS hv�
1 3 q t
PLAr NAME/SUBDIVISION NO. LOT NO� LID NO.
I LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved E3
RW Permit Required 13
Street Use Pernut Required C3
EXISTING PROPOSED Inspection Requarid [3
Sidewalk Required E3
REQUIRED DEDICATION FT Underground 13
Winne required E3
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES 13 NO 11 z
W
REMARKS Lu
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
LU
GGINEERING REVIEWED BY DATE
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FIRE REVIEWED BY DATE Lu
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VARIANCE OR CU
SHORELINEORADB#
INSPECTION01
SEPA
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REQ'D
UrYES ON
COMPLETED
EXEMPT
CAN
ZONEO^
SIGN AREA
HEIGHT
WAIVER 1211'
P,
ALLOWE
PROPOSED
ALLOWED PROPOSED
STUDY 13
-4 -V'
14, 1
7A
LOT COVERAGE
REQUIRED SETBACKS (FT)
OSED SETBACKS (FT.)
=T
ALLOWED PROPOSED
FRONT SIDE RE71
UR SIDE REAR
N6
h
z
PARKING
LOTAREA
PLANNING REVIEWED BY
DATE
REQ'D PROVIDED
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REMARKS
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TYPEMZECI
SPECIAL INSPECTION
REQUIRED E3 YES
REMARKS
GEOTECH R
BY:
STRUCTURAI DEYId—N
BY: Qte
CONSULTANT
Description
Plan Check
H I EATSOURCE LOT SLOPET_7
VESTED DATE
Building Permit
PLAN CHECK NO'
Plumbing
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Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
Grading
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
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Ui
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
Engr. Inspe ction
PERMIT LIMIT. SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, H EIRS, ASSIGNS AND SUCCESSORS
Fire Review
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
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
Landscapeinsp.
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
X1
Recording Fee
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
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
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
WORKMEN'SoMf�NSATION INSURANCE AND RCW 18:27.
,
SIGNA RE I I WN ENT DATE SIGNED
(425)
771-0220(
ATTENTION
�XT a 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 17-
a!lyll"Illn-vl, 7
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1 09 / IIBC1 10 1 IRC1 1
91
10104 PRESS HARD - YOU ARE
MAKI G 4111
OCCUPANT
GROUP
OCCUPANT
LOAD
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FEE Description
6.00 IState Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided
FIWLS SIGNATURE DATE it
REIEASEDBY DATE I I I
PIES
ORIGINAL -FILE YELLOW - INSPEtTC
PINK -OWNER GOLD - ASSESSOR
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