20060013.pdfJ� DATE RECEIVED
PERMIT EXPIRES
OOOCITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
ADDRESS
OW ER OF BUSINESS
LI % PLAT NAME/SUBDIVISION NO. LO O. LID NO.
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PROPERTY TAX ACCPUNT PAR L NO. VARIANCE OR Cu SHORELINE OR ADBp INSPECTION SEPA
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5 NEW ❑ RESIDENTIAL ❑ PLUMBING / MECH ❑ WAIVER ALLOWED PROPOSED ALLOWED PROPOSED
COMMERCIAL COMPLIANCE OR ❑ STUDY
ADDITION `rt ❑ CHANGE OF USE LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
❑ MIXED USE ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN i
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❑.REPAIR ❑ ❑ ( X FT.) PARKING LOTAREA PLANNING.REVIEWEDBY DATE a
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CARPORT ❑ ROCKERY FIREALARM
i(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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m ST DWELLING TYPE OF CONSTRUCTION CODE OCCUPANT
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GEOTECH REPORT m
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STRUCTURAL DESIGN
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VALUATION
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Description FEE Description FEE
HEAT SOURCE LOT SLOPE°b VESTED DATE Plan Check State.Surcharge
PLAN CHECK N0: Building Permit i — City Surcharge
Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO Mechanical
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
R DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC,) WILL REQUIRE
t SEPARATE PERMISSION, Grading
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n PERMIT APPLICATION: SEE'ECDC 19.00,005(A)(5) Engr, Review Recording Fee
PERMIT LIMIT: SEE ECDC 19.00.005(A)(8)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Ir1SpeC110n Plan Chi(. Deposit
in *APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF Fire Review Receipt
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY Fire, Inspection Total Amt. Due
G FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE p
J DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
= NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.* Landscape Insp• Receipt #
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF CALL This application is not a permit until signed by the
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC•
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED FOR INSPECTION Building Oeipt i a knowl Deputy: and a pr are paid. and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO receipt is acknowledged in space provided
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.4
ne.` 6FI SI TURE DATE
SIGNATURE ( NERAG T) 1 DATE SIGNED 771-O22U15A /
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ATTENTION EXT. 1333 1
111p� 1 )/07 A4002
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. UBC109 / IBC110 / IRC1109 ORIGINAL. •FILE YELLOW •INSPECTOR
PINK -OWNER •GOLD •ASSESSOR
6/05 PRESS HARD - YOU ARE MAKING 4 COPIES
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