20050824.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
CITY ZIP TELEPHONE
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NAME
I 1PERMITEXPIRES J 1L
PERMIT
NUMBER WLJOB
ADDRESS �-� SUITEIAPT#
PLAT NAME/SU BDIVISION NO. OT NO LID NO
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved ❑
RW Permd Required ❑
Street Use Permd Required ❑
EXISTING _ PROPOSED Inspection Required ❑
Sldewal4 Required ❑ -
REQUIRED DEDICATION FT Underground ❑
Winnit required ❑
METER SIZE LINE_ NARift Nn OF�FIXTi IRFS PRV REQUIRED
YES 13 NOD 3
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CITY ZIP TELEPHONE (� FIRE REVIEWED 0.v pj
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STATE LICENSE NUMBER EXPIRATION DATE CHnK VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
L.%�REO'D COMPLETED EXEMPT
v O YES 13NO
PROPERTY TAX ACCOUNT PARCEL NO. ���/// CAq ZONE SIGN AREA HEIGHT I`
O .+L 0.! , /� /.I WAIVER i� - ALLOWED PROPOSED ALLOWED PROPOSED
P_CJ �( 7 (� —1 STUDY O
❑ NEW RESIDENTIAL ❑ PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR c7
❑ COMMERCIAL COMPLIANCE OR i
❑ ADDITION ❑ MIXED USE CHANGE OF USE i
❑ PARKING LOT AREA PLANNING REVIEWED BY DATE g
❑REMODEL
MULTIFAMILY ❑ SIGN REO'D PROVIDED
❑❑GRADING ❑ FENCE
REX FT.) REMARKS
PAIR CYDS (
❑ DEMOLISH TANK ❑ OTHER
_ ❑ CARPRETAININGGE WALL LER
ORT ❑ ROCKERY ❑ FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
,� , _'�1 '9 j�� TYPE NSTR CTION C� GROUP
v L Vl a jls�s
w NUMBER NUMBER OF
C OF l DWELLING l SPECIAL INSPECTION CONSULTANT OCCUPANT .
O STORIES ri UNITS ! LOAD
REQUIRED 13 YES
DESCRIBE WORK TO BE DONE
S REMARKS i
%
GEOTECH REPORT �
BY: m
w� _S
STRUCTURAL DESIGN
_ BY:
v VALUATION
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$
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE
Building Permit City Surcharge �
PLAN CHECK NO: Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC Grading
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g
t SEPARATE PERMISSION,
a Engr. Review
W PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
IL PERMIT LIMrr: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Ellgf. Inspection
•APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
Lu IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
LVIOLATION
LAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE
ED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due
LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.•
Recording Fee Receipt #
Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF This application Is not a permit until signed by the
NER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• CALL Building Official or his/her Deputy: and Foes are paid, and
D IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
ATION OF THE CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTIONreceipt s acknowledged in space providedEN'S COMPE ATION I URANCE AND RCW 18:27.E DATURE (00 O AGENT): ^ DATE SIGNED (425)
771w0220 RELEA E DAT
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• 0 GINAL -FILE YELLOW -INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC1101 IRC1100 PINK -OWNER • GOLD - ASSESSOR
10/04 PRESS HARD w YOU ARE MAKING 4 COPIES
FINAL PROJECT APPROVAL FORM