20050056.pdfFOATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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STATE LICENSE NUMBER EXPIRATION DATE Cl-ACKED BY]
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PROPERTY TAX ACCOUNT PARCEL NO.
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RESIDENTIAL
PLUMBING / MECH
COMMERCIAL
COMPLIANCE OR
ADDITION
MIXED USE
CHANGE OF USE
REMODEL
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SIGN
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REPAIR
GRADING
CYDS
FENCE
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DEMOLISH
TANK
OTHER
GARAGE
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RETAINING WALL
FIRE SPRINKLER
CARPORT
ROCKERY
FIREALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
CS
NUMBER
NUMBER OF
PERMIT EXPIRES
PERMIT
NUMBER
JOB
ADD RIESS 2;2�
SUITEIAPT111
J46
PLAT NAME!SUBDIVI SION NO
LOT NO
LID NO
I
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required
Street Use Permit Requited
EXISTING PROPOSED
rispection Required
Sidewalk Requifeu
REQUIRED DEDICATION FT
Undwgiouna
Wiring rfquired
METER SIZE
LINE SIZE
NO. OF FIXTURES
. PRV REQUIRED
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YES 13 No13
REMARKS
OWNEMCONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ENGINEERING REVIEWED BY DATE
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FIRE REVIEWED BY DATE ILL!
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VARIANCE OR CU SHORELINEORADB# I INSPECTION SEPA
REO'D COMPLETED I EXEMPT
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CA# ZONE SIGN AREA HEIGHT
WAIVER 13 ALLOWED ROPOSED ALLOWED PROPOSED
STUDY [3
LOT COVERAGE REQUIRED SETBACKS [FT) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
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REQ'D I PROVIDED
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WELLING
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SPECIAL INSPECTION
REQUIRED DYES
DESCRIBE WORK TO BE DONE
REMARKS
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GEOTECH REPORT
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STRUCTURAL DESIGN
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VALUATION
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Description
Plan Check
HEME
LOTSLOPE%
VESTED DATE
Building Permit
PLAN CHECK NO:
Plumbing
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
2
oc PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
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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
uj IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
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
0 NOR IMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Fire Review
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Fire Inspection
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Recording Fee
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
CONSULTANT
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S CompENSAjW,*WkURANCE AND RCW 18:27.
FEE
OCCUPANT
GROUP
OCCUPANT
LOAD
IPE TEST WRIST
D-BY CITY INSPE_
AVITS S ALL NC
Description
State Surcharge
City Surc harge
Base Fee
FEE
Plan Chk. Deposit
Receipt #
Total Arnt. Due
Receipt # 01
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Foes are paid, and
receipt is acknowledged in space provided
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DATIESI NED P'. Tfl
IGN RE (OWN (425)
-0220
q0 771 E 4LA I!
; 7TNTION 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-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 if IBC110 If IRC110.
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9 /Fin.
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