20050051.pdfDATE RECEIVED r i
[PERMIT EXPIRES
CITY OF EDMONDS tS
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CONSTRUCTION PERMIT APPLICATION ^ SUITE/APT#
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OWNER NAME NAME OF ByUgINESS
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MAILING ADDRESS l / 111 �L LID FEE S
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/�j,/ IGHT OF WAY PER OFFICIAL STREET MAP RW CP PermitReqApproved ❑
,G.L„I 1✓ 7 L s�) I ��Y �J j RW Permit Required ❑
Street Use Permit Required ❑
CITY ZIP TEL PHONE PROPOSED Inspection Requited ❑
�—> l - Sidewalk Required ❑
v 2'S % L P7ED DEDICATION FT undorground ❑ re cared ❑NAME SIZE LINE SIZE NO. OF FIXTURES. PRV REQUIRED
YES ID NOD z
ADDRESS SmICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE z
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TELEPHONE
NAME CB�N
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ADDRESS
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FIRE REVIEWED BY DATE
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STATE LICENSE NUMBER EXPIRATION DATEBY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
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CA# ZONE SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO.
✓V 10103,
I` ,r � WAIVER O ALLOWED PROPOSED ALLOWED PROPOSED
3 , 7_ 6V STUDY 0
❑ NEW 0 RESIDENTIAL PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS AR
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ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
❑ COMMERCIAL
ADDITION ❑ COMPLIANCE OR
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MIXED USE CHANGE OF USE
❑
❑
REMODEL ❑ PARKING LOT AREA PLANNING REVIEWED BY DATE MULTIFAMILY ElSIGN REO'D PROVIDED
❑❑ GRADING ❑ FENCE X FT.) REMARKS
REPAIR CYDS
❑ DEMOLISH ❑ TANK ❑ OTHER
❑
CARPORT ❑ ROCKERY WALL E:]FIRE ALARM SPRINKLER
(TYPE OF USE, BUSINESS ACTIVITY) EXPLAIN:
TYPEQF-CONSTRUCTION CODE OCCUPANT
GROUP
NUMBER NUMBER OF
OF� DWELLING SPECT L INSPECTION CONSULTANT OCCUPANT
STORIES
L. LG, UNITS LOAD
REQUIRED O YES'
DESCRIBE WORK TO BE DOVE
REMARKS
GEOTECH REPORT
V \ al V J BY:
STRUCTURAL DESIGN
BY:
lit.. VALUATION
Is
Description FEE Description FEE
Plan Check Slate Surcharge
H T SOURCE LOT SLOPE% VESTED DATE
Building Permit City Surcharge
PLA CHECK NO: Plumbing Base Fee 1
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY: ANY CONSTRUCTION ON THE PUBIC
I5 DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE EC DC 19.00.005(A)(5)
> PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review. Plan Chk. Deposit
L IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
E EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
Q ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
r FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE --
0 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape insp. Total Amt. Due
= NOR 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 his/her Deputy: and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED receipt is acknowledged in ace provided.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION p g p
WORKMEN'S COMPENSATION INSURANCE AND RCW 13:27, OF LS SIGNA U E DA E
N' Stiff n DATE GNJED (425)SGNA RE (OWNER `
DBY DAT�T1-0220 RELEA
A#IfNTION 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, UBC1o9 I IBC110 I IRC110, PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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