20050104A.pdfI
CITY
DATE RECEIVED
PERMIT EXPIRES
PERMCITY OF EDMONDS NUMBIER
CONSTRUCTION PERMIT APPLICATION ooREss SUITE/AP
ER NAMEINAME OF BUSINESS .
�0J ^ PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
2. F -F LID FEE 5
G ADDRESS
_ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW pri2L 2mer
Approve 0
71 J Street use Ponn,t Required �
ZIP TELEPHONE EXISTING PROPOSED _ inspection Require O
Sidewalk Require O
/ Underground
N! REQUIRED DEDICATION FT Winn re uved O
h S o � .•-� � — - - — -.
METER SIZE LINE SIZE NO. FI%TURES PRV REQUIRED
J
CcbAlob.
YES O NO O Z
FE
W
W
W
REMARKS z
L/ �' - OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
J j �7 1 L W
TELEPHONE 7
• N)CF Q0n) ENGINEERING REVIEWED BY
FIRE REVIEWED BY
z CITY —� ZIP TELEPHONE
0 li /
STATE LICENSE NUMBER E 1RATION
Ke 4 � 7, 62z
e PROPERTY TAX ACCOUNT PARCEL NO.
❑ NEW
❑ ADDITION
REMODEL
❑ REPAIR
❑ DEMOLISH
GARAGE
Cl CARPORT
(TYPE OF USE, F.
NUMBER
OF
STORIES
Z075LO
W4643
❑
RESIDENTIAL APLUMBING / MECH
COMMERCIAL COMPLIANCE OR
❑ MIXED USE 1:1CHANGE OF USE
❑ MULTIFAMILY ❑ SIGN
❑GRADING FENCE
CYDS ❑ ( X_
Oa R
❑ TANK '
RETAINING WALL FIRE SPRINKLER
❑ ROCKERY ❑ FIRE ALARM
NUMBER OF
DWELLING /
UNITS
DATE
DATE W
S
OR CU
SHORELINE
OR ADB#
INSPECTION
SEPA
n
REQ'D
COMPLETED EXEMPT
CONSULTANT
REQUIRED 0 YES
O YES ONO
GEOTECH REPORT
ZONE
SIGN AREA.
HEIGHT
VALUATION
ALLOWED PROPOSED
ALLOWED PROPOSED
EREO'D
ERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
PROPOSED
FRONT SIDE REAR
FRONT LIRSIDE REAR
G
LOTAREA
PLANNING REVIEWED BY
DATE
OVIDED
FT.) I REMARKS
TYPE OFqPNSTRUCTIONya
n
v
SPECIAL INSPECTION
CONSULTANT
REQUIRED 0 YES
REMARKS
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
$ //% 177`''
OCCUPANT 1�
GROUP
OCCUPANT
LOAD
Description FEE Description FEE
Plan Check �� State Surcharge
HEAT SO RCE LOT SLOPE% VESTED DATE
Building Permit } City Surcharge
Affi
PLAN CHECK NO: Plumbing Base Fee
G egg
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC Gradin
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC,) WILL REQUIRE g
SEPARATE PERMISSION, Engrg Review
PERMIT APPLICATION: SEE ECDC 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
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF Fire Inspection Receipt #
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND p
r 517 O;q pie)
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY /�/1
c FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Total Amt. Due �0 v
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. ! _
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' Receipt # +
Recording Fee
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 /s 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 FOR INSPECTION receipt is acknowledged in space provided
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S CO ENSATION INSURANCE AND RCW 18:27. FI LS SIGN" f % `TE
DATE SIGNED 1425) / �.�`-r`' / e
NE
"GU R7AG):
c NNN
' 1 T 771 -0220 L 'SED BY D E
eo
t- s
EXT. 1333
TE NIv, 44
IT IS UNLA FUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL -FILE YELLOW
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 I IBC110 I IRC110. PINK • OWNER GOLD P
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
V
O
rn
cM
My
�0
C1 17
C
�1C
=m
mZ
ID
C
rX
O "11
mm_
0 N
nr
M
CC4
r Z
D
Z
2
N
O
0
Ir
I