20050045.pdfFDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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STATE LICENSE NUMBER
EXPIRATION DATE
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PROPERTY TAX ACCOUNT PARCEL NO.
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PLUMBING / MECH
1 ADDITION
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MIXED USE
CHANGE OF USE
1:1 REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
CYDS
FENCE
( x —.FT.)
DEMOLISH
TANK
OTHER
GARAGE
RETAINING WALL
FIRE SPRINKLER
CARPORT
ROCKERY
FIREALARM
:1 (TYPE OF USE, BUSINESS ACTIVITY).EXPLAIN:-
PERMIT EXPIRES
PERMIT
NUMBER
JOB
ADDRESS
SUITEIAPTH
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PLAT NAME/SUBDIVISION NO.
Lot NO
LID NO.
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LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPApproved
RW Permit Required
Street Use Permit Requited
EXISTING
PROPOSED
inspection Required
Sidewalk required
REQUIRED DEDICATION
FT
Undragiound
Wiring required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
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YESC3 NOM
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ENGINEERING REVIEWED BY DATE
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Description
FEE
Description
FEE
_____7ESTED
Plan Check
State Surcharge
HEAT SOURCE
LOTSLOPE016
DATE
Building Permit
City Surcharge
PLAN CHECK NO:
Plumbing
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Grading
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION. —
Engr. Review
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PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
Fire Review
Plan Chk. Deposit
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
LandscapeInsp.
Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Recording Fee
Receipt #
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 I DING THE WOR AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
CALL
Building Official or his/her Deputy: and Fees are paid, and
IN VIOLAT OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
receipt is acknowledged in space provided.
FOR INSPECTION /_� I
WORKMEYE, !�� NSATIO144 , NSURANCE AND RCW 18:27.
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SIGNMINER A6iNT): DAT NED
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RE(EAStD 134_�
J,/ktTENTION
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 / IRC110-
PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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