20060518 (2).pdfIDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS . r
ZIP
NAME
ADDRESS
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CITY ZIP TELEPHONE
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/& I I PERMIT EXPIRES
PERMIT �� r
NUMBER � % , �)f:
JOB SUITE/APTu
ADDRESS
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TLSCPApprovea O
RW Pmmil SPoi red . ❑
, ...._ Street Use Perma Reliaed C3
EXISTING
_._.PROPOSED _InspectionReQw�ed O
Sldenai. Heqwred I7
REQUIRED DEDICATION_ FT Underground O
wifing r0fiLblea 0
METER SIZE LINE SIZE NO. OF FIXTURES PRV REOUIRED
YES 0 NOC3
REMARKS _
OWNER,CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE ¢
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W
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ENGINEERING REVIEWED BY DATE
RECYCLE REVIEWED BY DATE
PUBLIC WORKS REVIEWED BY
SAE LICENSE NUMBER EXRIPIA11014 DATE CH KED FIRE REVIEWED BY DATE w
PROPERTY TAX ACCOUNT PARCEL NO. l/ VARIANCE OR CU SHORELINE OR ADBn INSPECTION SEPA
Q REO'D COMPLETED EXEMPT
J-
V ! / 0 YES 0 NO
CAN ZONE SIGN AREA HEIGHT
NEW ❑ RESIDENTIAL PLUMBING / MECH 0 WAIVER ALLOWED PROPOSED ALLOWED PROPOSED
COMMERCIAL COMPLIANCE OR O STUDY
❑ ADDITION vink❑ CHANGE OF USE. LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
13 ALLOWED USE ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
❑ REMODEL❑ MULTIFAMILY ❑ SIGN z
z
❑
REPAIR ❑ GRADINGCYDS ❑ ENCS X FT.) PARKING LOT AREA PLANNING REVIEWED BY DATE a
❑ DEMOLISH ❑ TANK ❑
OTHER REQ'D PROVIDED
z ❑GARAGE RETAINING FIRE
CARPORT ❑ ROCKERY WALL ❑ FIREALARM SPRINKLER REMARKS
P (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:.
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c NUMBER NUMBER OF MENNEN
M OF DWELLING
O STORIES UNITS TYPE OF CONSTRUCTION CODE OCCUPANT
n Lj/A%' GROUP
DESCRIBE WORK TO BE DONE / �f// C) 03V
SPECIAL INSPECTION CONSULTANT OCCUPANT
REQUIRED I3 YES LOAD
REMARKS t7
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GEOTECH REPORT m
BY:
STRUCTURAL DESIGN
BY,
VALUATION
$
Description FEE Description FEE
HEAT SOURCE LOT SLOPE4b VESTED DATE Plan Check State Surcharge
PLAN CHECK NO: Building Permit City Surcharge
Plumbing Base Fee 2 z_
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED: THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
t SEPARATE PERMISSION. Grading
¢PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5) Engr, Review RecordingFee
IL PERMIT LIMIT: SEE ECDC 10.00.005(A)(6) g '
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr: Inspection Plan Chk. Deposit
in
*APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
L 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
Q ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY-�
= FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE Fire Inspection Total Amt. Due ` 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 tl'
MENEM-- 000001 MINES
MENNEN
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 CALL This application is not a permit until signed by the
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• Building Official or his/her Deputy and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED FOR INSPECTION
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. (425) OFFI SIG URE DATE
SI T RE ( N R OR AGEj): DATE SIGNED J `14 41009
n 771-0220
R � DATE_
EXT. 1333
AlTENTION
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 if IBC110 I IRC110' ORIGINAL •.FILE YELLOW INSPECTOR
PINK -OWNER •GOLD •ASSESSOR
6/05 PRESS HARD = YOU ARE MAKING 4 COPIES
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