20050023.pdfI
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PERMIT EXPIRES
CITY OF EDMONDS
13ERMIT
NUMBER
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SUITEIAPTO
CONSTRUCTION PERMIT APPLICATION
ADDRESS '7" L.,J
OWNER NAMEINAME OF BUSINESS
PLAT NAMEISUBDIVISION NO.
LOT NO.
LID NO.
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MAILING ADDRESS
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Peirnit Required
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EXISTING _ PROPOSED
Street Use Pornrit Required
Inspection Required
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CITY ZIP
TELEPHONE
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REQUIRED DEDICATION FT
S,d,nvall Required
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NAME
METER SIZE NE SIZE NO. OF FIXTURI
PRV REQUIRED
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REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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RESIDENTIAL LOT COVERAG REQUIRED SETBACKS (FT.)
11 NEW PLUMBING I MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
COMMERCIAL COMPLIANCE OR
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PARKIN LOTAREA PLANNING REVIEWED BY DATE 5
1:1 REMODEL MULTIFAMILY SIGN REO'D PR VIDED 116
GRADING FENCE
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1:1 DEMOLISH TANK OTHER
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Plan Check State Surcharge
HEAT SOURCE LOTSLOPE% VESTED DATE
Building Permit City Surcharge
PLAN CHECK NO: Plumbing Base Fee
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Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC Grading
DONMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
W
IL PERMIT LIMIT., SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCES SORS Fire Review Plan Chk. Deposit
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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 #
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 Landscapelnsp. Total Amt. Due
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee Receipt # P
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPEIZATION 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 hisMor Deputy: and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED receipt is ac�nowledged in space provided.
IN VIOLATION OF_,jHE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMENP FrEN\SATION INSURANCE AND RCW 18:27. DITE
I . OFFICIALSSI[,T 1,
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SIGN T tiFtNERO.,,fG.VT): DATE SIGNED (425)
771.0220 RELEASED BY DAIE
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 - INSPE'c,rOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 f IBC110 if IRC110. PINK -OWNER - GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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