20050060.pdfFDATE �RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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STATE LICENSE NUMBER EXPIRATION DATE C E
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PROPERTY TAX ACCOUNT PARCEL NO.
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14 RESIDENTIAL
PLUMBING �t �H
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COMPLIANCE OR
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MIXED USE
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MULTIFAMILY
SIGN
REPAIR
GRADING
CYDS
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DEMOLISH
TANK
OTHER
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(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN;
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NUMBER
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PLAT'NAMEISU B D IVI SION NO. LOT NO LID NO
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved
RW Permit Required
Street Use Permit Required
EXISTING PROPOSED Inspeci,on Required
Sidewalk Roquirea
REQUIRED DEDICATION -__— FT Underground
Witinq rectuired
METER SIZE LINE SIZE URES PRV REQUIRED
1 YES C3 NOE3
REMARKS
OWNERj ACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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ENGINEERING REVIEWED BY
FIRE REVIEWED BY
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VARIANCE OR CU SHORELINE OR ADB,1 I INSPECTION SEPA
REQ'D I COIAPLFTED I EXEMPT
13YES 13NO
CA# ZONE SIGN AREA HEIGHT
WAIVER 13 ALLOWED , PROPOSED ALLOWED , PROPOSED
STUDY [3 1 1 1 .
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR
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PARKING LOTAREA I PLANNING REVIEWED BY DATE
REO'D PROVIDED
REMARKS
NUMBER NUMBER OF , I I I Tr �q �7 V
OF DWELLING SPECIAL INSPECTION
STORIES I- I UNITS REQUIRED 13YES
DESCRIBE WORK TO BE DONE
REMARKS
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
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no i4u�/ Description
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Plan Check
HEAT SOURCE LOTSLOPE% VESTED DATE
Building Permit
PLA(j4CHECK NO: Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION. Engr. Rev . iew
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
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T—CONSULTANT
FEE
OCCUPANT
GROUP
OCCUPANT
LOAD
Description
State Surcharge
City Surcharge
Base Fee
FEE
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
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
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION..
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
Recording Fee
III Receipt #
CALL
FOR INSPECTION
APPLICATION APPROVAL
This application is riot a permit until signed by the
Building Official or his/her Deputy! and Fees are paid, and
receipt is acknowledged in space provided
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
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
IN VIOLATION OF THE LA�LDR-CDN OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENS_A?qjRWLSUR*CE AND RCW 111:27.
OF LS GN URE /In ATE
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DATE Sl NED (425) __ / DATE!
771-0220 RELEAS-ED-BYI' t
EXT. 1333
IT IS/J)(LAI&ft TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A F011AL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL - FILE YELLOW - INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1091 IBC110 I IRC110. PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES -
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