20051147.pdf" FDATE �RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
M�qaz TrikMe,
MAILINGADDRESS
/05 --1 1PERMIT EXPIRES
PERMIT
NUMBER o2,605-- 11Y7
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PLAT NAM EISU B DIVISION NO. I LOT NO
1119M - 617 H. V\J PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
CITY ZIP TELEPHONE EXISTING P-ROPO SED
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STATE LICENSE NUMBER EXPIRATION DATE
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PROPERTY TAX ACCOUNT PARCEL NO. Nil I
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NEW RESIDENTIAL PLUMBING
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ADDITION COMPLIANCE OR
177 MIXED USE CHANGE OF USE
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REMARKS, ... . ......
OWNER/CONTRACTOR RESPONSIBLE FOR EROSIC
ENGINEERING REVIEWED BY
FIRE REVIEWED BY '
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LID NO.
LID FEE S
I ESCP Approved
RW Permit Required
Street Use Permit Required
Inspection Required
PRV REQUIR D
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DATE
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VARIANCE OR CU SHORELINE OR ADBI I INSPECTION I SEPA
REO'D COMPLETED I EXEMPT
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CA# ZONE SIGN AREA HEIGHT
WAIVER 13 ALLOWED , PROPOSED ALLOWED I PROPOSED
STUDY 13 1 1 1
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
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PARKING LOTAREA PLANNING REVIEWED BY DATE
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GRADING FENCE
REPAIR CYDS X FT.)
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REMARKS
DEMOLISH TANK OTH I ER
GARAGE RETAIN ING WALL FIRE SPRINKLER
CARPORT ROCKERY FIREALARM
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NUMBER OF
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CONSULTANT
OCCUPANT
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DWELLING
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STORIES �
UNITS
REQUIRED 13YES
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
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GEOTECH REPORT
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Description
FEE
Description
FEE
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Plan Check
State Surcharge
-HEAT SOURCE
LOfsLbPE% VeSIED DATE
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Building Permit
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City Surcharge
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[�LAN CHECK NO:
Plumbing
Base Fee
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Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Grading
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
2—
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
Engr. Inspection
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PERMIT LIMIT. SEE ECDC `19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) *APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
LLJ IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
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ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
D TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.* I
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 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 Foes are paid. and
IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
TION; AND receipt is acknowledged in space provided.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN,s COMPENSATION INSURANCE AND RCW 18:27. 0 1 SIGNA RE DATE
GENT): DATE SIGNED (425)
SIMIATURE (OWNER,%� r
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0 AA/tA DATE
771-0220 RE
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'ATTEN41ON U EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL - FILE YELLOW - INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 I IRC110. PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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