20050447.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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CITY ZIP TELEPHONE
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NAME
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PERMIT / J '
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ADDRESS Z�
PLAT NAME/SUB`DDIIV`I-SIIOON' NO. LOT NO LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved 0
RVI Permd Required 0
Street Use Parma Required 0
EXISTING PROPOSED inspection Required 0
SNowalk RoqulfDd 0
REQUIRED DEDICATION FT Underground O
Witino retruired 0
METER40ZE ES PRV REQUIRED
SEET TO 8 CLEANED OF EWM NOIR
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REMARKS �p�� i
OWN ER/OfNTFSM 1199BaL.44MOSIXI CA ROL A4GE
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MP SITE ONLY
ENGINEERING VI WED BY DATE
w. ADDRESS So DEMOLITION INSPECTION
CITY 21P TELEPHONE FIRE REVIE ED#OR INSPECTION REQUIREMENT$ATE W j
G� ) 5 91 q0ZO
STATE LICENSE NUMBER EXPIRATIO DATE H CKE BY VARIANCE OR CU SHORELINE OR ADBN INSPECTION SEPA t
_ 1 n X STI F REQ'D COMPLETED I EXEMPT
OYES
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CAN ZONE SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL O.
Q ' WAIVEALLOWED PROPOSED ALLOWED PROPOSED
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❑ NEWRESIDENTIAL ❑ PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
❑ COMMERCIAL COMPLIANCE OR z
❑ ADDITION ❑ CHANGE OF USE z
❑ MIXED USE PARKING LOT AREA PLANNING REVIEWED BY DATE g
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REO'D PROVIDED.
GRADING FENCE
❑ REPAIR ❑ CYDS ❑ ( X FT.) REMARKS
tDEMOLISH ❑ TANK ❑ OTHER
GARAGE x ❑ CARPORT E3RO ROCKWALL ❑ FIRE ALARM FIRE LER
CL (TYPE OF USE, BUSINESS OR ACT TY XP AIN:
TYPfi O C SRU ON OCCUP
/ GROUP NT /
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NUMBER NUMBER OF
OF DWELLING I SPECIAL INSPECTION CONSULTANT OCCUPANT
O STORIES I UNITS LOAD
o REQUIRED 0 YES
DESCRIBE WORK TO BE DONE „y
PAn
REMARKS
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MGEOTECH REPORT m
BY:
STRUCTURAL DESIGN
BY:
VALUATION
Description FEE Description FEE
Plan Check" State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE r /
Building Permit 1 }�'- City Surcharge
PLAN CHECK NO: Plumbing Base Fee 1
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC,) WILL REQUIRE Grading
� SEPARATE PERMISSION,
Engr. Review
PERMIT APPLICATION: SEE ECDC 19,00.005(A)(5)
LU PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)/ )
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection
U) "APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
ui
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
i 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 '_ )
j DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE LandSCape Ir1Sp. Total Anll. Due
=NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee Receipt # C
1 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 apermit until signed by the
THE OWNER. 1 AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• CALL Building Official or hisihor Depuy and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATIO , F�THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN' OMPE SATION INSURANCE AND RCW 18:27,. OFFICIA SSI NATURE DATE
SIGNATU (0 E AG DATES NE ( ) /
S� 425
r c 771 -0220 RELEASED dY ( DATE
ATTENTION 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, UBC1091 IBC110 1 IRC110. PINK -OWNER GOLD - ASSESSOR
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