20050038.pdf/"6N DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNS ME NAAME OF BUSINESS 1
1 " I J Usj r
MAILINd"ADDFtESS m _
0 515
CITYZIP TELEPHONE
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C ��
NAME
2tPERMIT EXPIRES l
PERMIT
NUMBERJOB M
ADDRESS q,�% ��- SUITEIAPT#
PLAT NAh1E/SUBDIVISION NO �i✓ 'L`'OIT NO, LID NO.
_ LID FEE 8
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApproved
RW Permit Regwrgd 0
Street Use Parma Requved 17
EXISTING PROPOSED _ InspKtion Required Ia
—^ —� Sidewalk Required 13
REQUIRED DEDICATION FT Underground O
_— -- —
Wiring required E3
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES O NO O O
z
w
REMARKS w
OWNEWCONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE z
15z
w
1_1J% •i Ll� ENGINEERING REVIEWED BY DATE
zo A DRES .�-
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gt /ry FIRE REVIEWED BY DATE w
z CIT ZIP �. TEL EPHON I
O UZ 2
STATE LICENSE NUMBER EXPIR TION ATE . C BY
VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
q REQ'D COMPLETED EXEMPT
f OYES � NO
7GC
CA# ZONE SIGN AREA HEIGHT
Q PROPERTY AX A C UNT 11
PARCEL NO.
U n WAIVER ALLOWED PROPOSED .ALLOWED PROPOSED
LU ZL� 0 STUDY O
❑ NEWSIDENTIAL ❑ PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
\CCC ALLOWED PROPOSED FRONT' • SIDE REAR FRONT UR SIDE REAR O
❑ OMMERCIAL COMPLIANCE OR a
El El
ElMIXED USE ❑ CHANGE OF USE z
❑❑ ❑ SIGN REQ'D AR PLOT AREA PLANNING REVIEWED BY DATE g
REMODEL MULTIFAMILY PROVIDED
GRADING FENCE
❑ REPAIR ❑ CYDS ❑ ( X FT.) REMARKS
DEMOLISH ❑ TANK j'� OTHER
z ❑ CARPORT GARAGE ❑ RETAINING FIRE LER
RO KERY WALL ��❑rr FIRE ALARM
a(TYPE OF USE, BUSINESS O C Y XPLAIN:
OCCUPAIx TY OF 71 GROUP NT
U
GNUMBER NUMBER OF
OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
p STORIES i UNITS LOAD
0 REQUIRED YES
DESCRIBE WORK TO BE DON p.Vfl
REMARKS z
0
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
$
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE
Building Permit L City Surcharge
PLAN CHECK NO: Plumbing Base Fee
'✓ Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
f BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBIC
i DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
z PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
a PERMIT LIMIT: SEE ECDC.19.00,005(A)(6)�
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. InspeCUon
U) *APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
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 Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE �y
o DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due
0NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.•
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 hlslher Deputy: and Fees are paid, and
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 receipt is acknowledged in space provided.
WORKMEN'S COMPENSATI URANCE AND RCW 18:27. FF 1 1 A RE !, DA E/
%>VSIGNATUR OWN OR ENT) DATE SIGNED (425)
771 =0220 RELEASED BY DATL
L
ATTENTION EXT. 1333
ITIS 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, UBC1091 IBC110 I IRC110. PINK -OWNER GOLD • ASSESSOR
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