20050228.pdfDATE RECEIVED
I PERMIT EXPIRES
PERMIT
CITY OF. EDMONDS NUMBER ( � z
CONSTRUCTION PERMIT APPLICATIONJoB - SUITE/APT#
ADDRESS 5 q --
OWNER NAMEINAME OF BUSINESS
PLAT NAMEISUBDIVISION NO. LOT NO. LID NO,
MAILING ADDRESS LID FEE $
L. ..'TESCPA roved E3
PUBLIC PER OFFICIAL STREET MAP
,•`7 "'�%-r�, (.' , �.� RW Permit ll Required E3
CITY 21P TELEPHONE EXISTING PROPOSED Street Use Permit Required E3Inspection Required
'� 1 1 ' 7 '� Sidewalk Required.
1 , , �_ 7 •� r , Underground 0
f (�' „li L _ 7 / t/�ff_ REQUIREDDEDICATION FT_ W,tin required
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NAME METER SIZE LINE SIZE N0, OF FIXTURES PRV REQUIRED
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ADDRESS REMARKS i
U ! - OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITYs rZIP TELEPHONE
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NAME/ CBL#
- \-' ENGINEERING REV ED BY z DATE
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FIRE REVIEWED BY DATE
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STATE LICENSE NUMBER EXPIRATIO DATE C Y VARIANCE ORCU SHORELINE OR ADB# INSPECTION SEPA
07(- , ,/ �. IREQ'D, COMPLETED E EMPT
OYES NO
a PROPERTY TAX ACCOUNT PARCEL NO. `- i l' CA# ZONE SIGN AREA HEIGHT
J _ WAIVER 0 ALLOWED PROPOSED ALLOWED PR POSED
W+ �' 7)L -�' ��~�j� �, r' -"(i STUDY O % C
❑ NEW RESIDENTIAL ❑ PLUMBING / MECH LOT COV Q REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED OPOSED FRONT SIDE REAR FRONT UR SID REAR
❑ COMMERCIAL COMPLIANCE OR O I l j i 1
ADDITION ❑ �S S •LI.�
E3 MIXED USE CHANGE OF USE �0 0 I S
❑REMODEL PARKING LOTAREA PLANNING REVIEWED BY DATE g
1:1 MULTIFAMILY ❑ SIGN REQ'D PROVIDED Y'S 1
❑ REPAIR ❑ GRADINGCYDS ❑ FENCE X FT.)RE REMARKS
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❑ DEMOLISH ❑ TANK ❑ OTHER
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❑ GARAGE ❑ RETAINING WALL ❑FIRE LER
Z CARPORT ROCKERY FIRE ALARM ( /
(TYPE OF USE, BUSINES R ACTIVITY) EXPLAIN:
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i u �� / /-� j� = TYPE OF CON1$gUCTION C DJ .w OCCUPANT .
Lu NUMBER I NUMBER OF J r
c 'OF DWELLING
SPECIAL INSPECTION CONSULTANT OCCUPANT
M STORIES UNITS LOAD
DESCRIBE WORK TO BE DONE REQUIRED YES.
REMARKS z
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GEOTECH REPORT
BY: rn
! i STRUCTURAL DESIGN
.1, BY:
1` l ; c Mi r VALUATION
(r Description FEE Description FEE' .
Plan Check -- Stale Surcharge .7
HEAT SOURCE LOT SLOPE% VESTED DATE
Building Permit City Surcharge
PLAN CHECK NO: Plumbing Base Fee `� r
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO MBChanIC21
!_ BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
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wPERMIT APPLICATION: SEE ECDC 19.00.005(A)(5) Engr. Review
CL 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
.jIN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
a2 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
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due Lj
= NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.* r
Recording Fee Receipt # y
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application Is not Depupermty:
ann dl signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deeputy: d Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged to space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27,
ICIALS S GNATURE DATE
DATE SIGNED
TUA25)
/ r A
S;IrOW ER OR AGENT): 4� � ( C.CC "�I D 771 0220 R EDBY - DATE
ATTENTION - EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL01
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL FILE YELLO INSP TOR
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC1091 IBC1101 IRC110. PINK -OWNER • GOLD • ASSESSOR
110104 PRESS HARD = YOU ARE MAKING 4 COPIES
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