20050093.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
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CITY ZIP TELEPHONE
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NAME
ADDRESS
CITY ZIP
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NAME
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PERMIT EXPIRES
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PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RiGIIT OF WAY PER OFFICIAL STREET MAP
I ESCP Approved E3
RW Permit Required 13
EXISTING - PROPOSED
street Use Permit Roq'd E3
inspection ne4unod
Sidewalk Required
REQUIRED DEDICATION- Fl-
Underground
Wiring required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YE No 13
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BLE FOR EROSION CONTROL/DRAINAGE
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CITY ZIP TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE. CHFCKE13 BY
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PROPERTY TAX ACCOUNT PARCEL NO.
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NEW RESIDENTIAL MPL�UMB/ MECH
ADDITION COMMERCIAL COMPLIANCE OR
0 CHANGE OF USE
REMODEL MULTIFAMILY 0 SIGN
GRADING FENCE
REPAIR CYDS 13 1 x Fr)
OTHER
DEMOLISH TANK
GARAGE E3 RETAININGWALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
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NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES UNITS NUMBER
DESCRIBE WORK TO BE DONE
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VESTED DATE
PLAN CHECK NO: 14 /-1
ING REVIEWED BY DATE
FIRE REVIEWED BY DATE W
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VARIANCE OR CLI
SHORELINE OR ADB#
I' INSPECTION
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OYES ONO
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SEPA REVIEW
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SIGN AREA
ALLOWED PROPOSED
ALLOWED
HEIGHT
PROPOSED
EXP I
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LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (Fr.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT)
FRONT IJR SIDE REAR
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PARKING
REO'D I PROVIDED I
LOT AREA
I PLANNING REVIEWED BY
DATE
REMARKS
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OF CONSTRUCTION
CODE
OCCUPANT
ITYPE
GROUP
SPECIAL INSPECTION
OCCUPANT
REQUIRED
JAREA
LOAD
REMARKS
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PROGRESS INSPECTIONS PER UBC
108/FINAL INSPECTION REO'D 1-
VALUATION
$ 14D, -7
Description FEE Description FEE
Plan Check State Surcharge
Building Permit A� City Surcharge
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Plumbing Base Fee IR-115, 0�
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: ISO DAYS
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06 PERMIT LIMIT. 1 YEAR - PROVIDED WORK 19 STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit to
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF it
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND Fire Inspection Receipt_#
EVER NATURE. ARISING DIRECTLY OR INDIRECTLY
ALL CLAIMS FOR DAMAGES OF WHAT
11 Amt. Due
X FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF 1HIS PERMIT SHALL NOT BE Landscapeinsp. Total Amt. Due
!3 DEEMED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE A/
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- 161ol
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Recording Fee Receipt # f 11�1 I
I I L-15
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
D STATE LAWS REGULATING CONSTRUC- This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AN CALL as are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fe
IN VIOLATIONPF--�,IiE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged in space provided.
WOFIKMEN'SJRMPEYSATION INSURANCE AND RCW 18.27. OFFICIALS SIGNATURE TE
SIGNATURE WWNE OR AGENT) DATE SIGNED (425)
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771-0220 L 3Y DATE
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AlttNTION EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL FILE - YELLOW - 1��
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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