20050014.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINE S
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MAILING ADDRESS
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NAME
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PERMIT EXPIRES 7
PERMIT r
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PLAT NAM EISUBDIVISION NO. LOT NO. LL LID NNOO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved 0
RW Permd Roqu I�
street use Perrnd Required 133
EXISTING PROPOSED Inspection Required O
Sidewalk Required
REQUIRED DEDICATION FT Underground O
Witing required E3
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES 0 NO O _
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REMARKS w
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE z
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I STATE LICENSE NUMBER EXPIRATION DATE CK BY "8911 INS TION SEPA
f / �Yj _ REQ'D COMPLETED EXEMPT
l_ Y" YES NO
CA otlZO SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO.
WAIVER13 ALLOWED PROPOSED ALLOWED PROPOSED
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❑ NEW ❑ RESIDENTIAL PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR t,
El COMPLIANCE COMPLIANCE OR z
❑ ADDITION 13 CHANGE OF.USE z
❑ MIXED USE . PARKING LOTAREA PLANNING REVIEWED BY DATE ga
❑ REMODEL jR:6iIULTIFAMILY ❑ SIGN REO'D PROVIDED
GRADING FENCE
❑ REPAIR ElCYDS ❑ ( X FT.) RVAt'i/ `-
OTHER '
❑ DEMOLISH ElTANK 13
GARAGE ❑ RETAINING WALL13FFIRE SPRINK
IREA ARM
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Z ❑ CARPORT ROCKERY N1.✓
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(TYPE OF USE, BUSINESS O AC IVIITY) EXPL IN: NUJ
TYP '/% N GROUPANT
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NUMBER MER F
C OF 2 JtEBLLING�
SPECIAL INSPECTION CONSULTANT OCCUPANT
O STORIES ✓ UNITS LOAD
0 REQUIRED D YES
DESCRIBE WORK TO BE DONE
REMARKS i
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,l/OMiI= C. W1L� RISES ' .AIu�N VALUATION
V /-' Description FEE Description FEE
l �, %, `� Plan Check State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE `
Building Permit City Surcharge
PLAN CHECK NO: Plumbing �' j — Base Fee r
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO MCChanICBI
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC Gradin
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE.
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SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
Ile PERMIT LIMIT: SEE ECDC 19.00,005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engf. Inspection
Go "APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
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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 #
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 `
O NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
_ Recording Fee Receipt # 1
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 REE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• CALL Building Official or his/her Deputy: and Foes are paid, and
TION; AND IN I G THE WORK AUTHORIZED THERE NO PERSON WILL BE EMPLOYED
IN VIOLATIO O THE LABOR CODE OF THE S OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'SO PENSATIO RANCE AND W 1 :27. OFFJ6IALS IGN URE ATE
SIGNAT 0 NER 0 GENT): DATE SIGNED (425) ��J�--�� I 'r
771 -0220 RELEASLt BY DA TE
ATT ON EXT. 1333 ---_
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTla ORIGINAL •FILE YELLOW -INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109I IBC110 I IRC110. PINK -OWNER • GOLD - ASSESSOR
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