20050324A.pdf* DATE RECEIVED/
PERMIT EXPIRES 61Z, 7A c
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CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB UITE/APTN
OWNER NAMEINAME OF BUSINESS ADDRESS l J / 7 Cf J /CC� W ,
Aa O p P. I6 Cwl 1 TEIZ PAT NAMEISUBDIVISION`1NO. OT NO. (• jLLID NO.
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MAILING ADDRESS l 1 I� !` LID FEE 5
�� 1 I �� S, C��` PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApprovwd ❑
p 1 ��LLLL Y - RW Permit RegwrcA ❑
Street use Permit Required ❑
CITY ZIP TELEPHONE EXISTING PROPOSED Inspection Requited ❑
r -7' vp -7 Sidewalk Required ❑
�BD �� ��J - 17r — O!y / L REQUIRED DEDICATION FT Underground ❑
L Winn required ❑
NAME METER SIZE I E PRV REQUIRED
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ADDRESS REMARKS®I�� (��� w
OWNER/CONTRACT y SM O DRAINAGE _
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CITY 21P ITELEPHONE BE ACCEPTED W
NAME C9�
Was�'�,1 �onhe��u>u�S ENGINEERING REVIEWED BY DATE
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om dL �Ave FIRE REVIEWA
CITY ZIP TELEPHONE I , ^1 on fu +l_burning appliances passing LL
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STATE LICENSE NUMBER EXPIRAT N TE CHECKED BY VARIAN
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1� 1 4 V r 0 NO
CAN ZONE SIGN AREA. HEIGHT .
PROPERTY TAX ACCOUWAARPEL'%NO. j WAIVER 0 - ALLOWED PROPOSED ALLOWED PROPOSED
O/ vW W STUDY 13
❑ NEW . RESIDENTIAL g LUMBI/ MECH . LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR
❑ COMMERCIAL COMPLIANCE OR z
❑ ADDITION CHANGE OF USE z
❑ MIXED USE 1:1 CHANGE
LOTAREA PANNING REVIEWED BY DATE 5
REMODEL ❑ MULTIFAMILY ❑ SIGN REQ'D PROVIDED
GRADINGFENCE
REPAIR ❑ CYDS ❑ ( X FT.) REMARKS
❑ DEMOLISH ❑ TANK ❑ OTHER
GARAGE ❑ CARPORT ❑ ROCKERY RETAINING WALL FIRE FIREA ARM LER
(TYPE OF USE, BUSINESS OR,ACTIVITY) EX IN:
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H NUMBER NUMBER OF
CODA , 7GCRCOUUPPi
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OFDWELLING SPECIAL INSPECTION CONSULTANT OCCtfFANT
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REQUIRED 13 YES
DESCRIBE WORK TO BE DONE
REMARKS
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GEOTECH REPORT m
BY:
STRUCTURAL.DESIGN
` BY:
I� VALUATION.
Description FEEDescription FEE
Plan Check State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE
rXA Building Permit City Surcharge
PLAN CK NO: Plumbing � . �� Base Fee Q
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBIC Gradin
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g
'. SEPARATE PERMISSION.
It Engr. Review
i PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
6 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
U 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 #
C 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
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee A Receipt #
1 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 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 FOR INSPECTION receipt is acknowledged in space provided.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S ENSATION INSURANCE AND RCW 18:27, OF IAL IG T E DAT
SIGNATURE ( WNER RAG : DATEIGNED (425) L b�
Z7O� 771-0220 BELE S BY DA E
XMIA
ATT TI N EXT. 1333
IT IS UNLAWFU 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 if IRC110. PINK -OWNER GOLD -.ASSESSOR
10104 PRESS HARD = YOU ARE MAKING 4 COPIES
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