20060519 (2).pdfDATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
FR NAME/NAME OF BUSINESS
CITY
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NAME
ADDRESS
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ZIP/ I TELEPHONE
PERMIT
NUMBER
PERMIT EXPIRES
/2 ae/CJ
.'UB SUITEJAPT#
ADDRESS
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PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TLSCP APprorna
H544 Pmm i RecW,red
Street use Perm i Hegmrea
EXISTING PROPOSED ._._. PROPOSED __- inspentan Ruqu:rea
._. _. -_.. _._ Siaeaau RegUIM
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REQUIRED DEDICATION.^FT underymund_ W,rn
terttmea
METER SIZE LINE SIZE NO, OF FIXTURES PRV REQUIRED
YES ❑ NO ❑
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
NAME CBL# ENGINEERING REVIEWED BY DATE
ADDRESS RECYCLE REVIEWED BY DATE
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CITY ZIP TEL PHONE PUBLIC WORKS REVIEWED BY DATE
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STATE EICENSE NUMBER EXPIRATION DATE C CKED BY FIRE REVIEWED BY DATE
AM 71r -
! PROPERTY TAX ACCOUNT PARCEL NO. VARIANCE OR CU SHORELINE OR ADBIO
# INSPECTION SEPA
i� • REQ'D COMPLETED I E%Er/.PT
� 13 YES 0 NO
CA# ZONE SIGN AREA HEIGHT
❑ NEW ❑ RESIDENTIAL 19 PLUMBING / MECH ❑ WAIVER ALLOWED PROPOSED ALLOWED PROPOSED
COMMERCIAL COMPLIANCE OR E3 STUDY
❑ ADDITION ❑ CHANGE OF USE LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
1:1 MIXED USE ALLOWED PROPOSED FRONT SIDE REAR, FRONT UR SIDE REAR
❑ REMODEL 1:1 MULTIFAMILY ❑ SIGN
GRADINGFENCE
❑ REPAIR 1:1CYDS ❑ ( X FT:) PARKING LOT AREA PLANNING REVIEWED BY DATE
OTHER REO'D I PROVIDED
❑ DEMOLISH ❑ TANK ❑
❑GARAGE HETAINING WALL FIRE SPRINKLER REMARKS
CARPORT ❑ ROCKERY ❑ FIRE ALARM
` (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
ii
u NUMBER NUMBER OF
OF
DWELi LING . ! TYPE OF CONSTRUCTION CODE OCCUPANT
STORIES UNITS
/V IYA��y(�I•�,•. (52GROUP
DESCRIBE WORK TO BE DONE (f
SPECIAL INSPECTION CONSULTANT OCCUPANT
REQUIRED 13 YES LOAD
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REMARKS
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY'
VALUATION
Description FEE Description FEE
HEAT SOURCE LOT SLOPES; VESTED DATE Plan Check State Surcharge
PLAN CHECK NO: Building Permit City Surcharge S
Plumbing t Base Fee
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
J SEPARATE PERMISSION, Grading
F
PERMIT APPLICATION: SEE ECDC 19.00,005(A)(5)
1 PERMIT LIMIT: SEE ECDC 19.00.005(A)(0) Engr. Review Recording Fee
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr, Inspection Plan Chk. Deposit
n '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 t9
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
= ALI. CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY Fire Inspection Total Amt. Due
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
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 It
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 m space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27. (425) S SI 11 LIFE ATE
SIGN TRE (O N R OR AGENT DATE SIGNEDIx
L J J
I Q 771 =0220 1 11q
b U O C REL l Y DATE
EXT. 1333
ATTENTION
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 I IRC110. ORIGINAL •FILE PINK -OWNER YELLOW -INSPECTOR
GOLD •ASSESSOR
5105 PRESS HARD - YOU ARE MAKING 4 COPIES
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