20050970.pdfDATE RECEIVED
CITY OF EDMONDS
F
STRUCTION PERMIT APPLICATION
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PERMIT EXPIRESPERMIT
NUMBER CX00 5 ,O �y
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PLAT NAMEISUBDIVISION NO. LOT NO LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP rESCP Approved ❑
RW Permit Required ❑
EXISTING I Use Permit Requited ❑
QSECl. ++� . ns titan Required ❑
fired
So alk Required ❑
R dditjM .tom reqs Un( rground ❑
per! ul required ❑
o liar rellref)wal 1 am lappr PRV REQUIRED
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ENGINEERING REVIEWED BY
FIRE
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DATE
DATE u1
EXPIRATI9N DATE _CHECKED BY VARIANCE R& SIiORELINE OR Aub"-INSrcel ■A vAMP00
REQ'
t'211 V (lb,
I -JI PROPERTY jA*ACCPUNT PARCEL NO.
93
❑ NEWO RESIDENTIAL LUMB ! MECH
COMMERCIAL `!"� COMPLIANCE OR
❑
ADDITION ❑ CHANGE OF USE
❑ MIXED USE
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN
❑❑ GRADING ❑ FENCE X
REPAIR CYDS
❑ DEMOLISH TANK ❑
OTHER
❑GARAGE FIRE
CARPORT ❑ ROCKE YG WALL ❑ FIREALARM SPRINKLER
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
TYPE S- T,RI,I CO ucwrnrvl^.
v '�1 /1 GROUP J
cNUMBER NUMBER OF
OF DWELLING, SPECIAL INSPECTION CONSULTANT OCCUPANT
p STORIES v UNITS - LOAD
DESCRIBE WORK TO BE DONE REQUIRED YES
,Q -(REMARKS
' /✓ .,4 GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
�J VALUATION
ASO �h $
f ���� Description FEE Description FEE
/t,fU �Gt f `44P / � ` Plan Check State Surcharge
HEAT SOURC LOT SLOPE% VESTED DATE
Building Permit City Surcharge
PLAN CHECK NO: PlumbingitBase 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 ran g
t SEPARATE PERMISSION.
s Engr. Review
w PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
CL PERMIT LIMIT: SEE ECDC 19.00,005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection
•APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
Uj 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 #
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 Receipt # al
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 Is not a permit until signed by the
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LAB CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged In spare provided.
WORKMEN'S COMPENSA
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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. UBC109 I IBC110 I IRC110. PINK -OWNER GOLD - ASSESSOR
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