20050106.pdfDATE RE
CITY OF EDMONDS
.CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUS114ESS
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FPERMITEXPIRES
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PLAT NAMEISUB DIVISION NO.
LOT NO
LID NO,
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LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
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RW Permit Required
Street Use Porl"it Required
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EXISTING PROPOSED
Inspeclion Required
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Sidewalk Required
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REQUIRED DEDICATION
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Underground
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METER SIZE
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LINE SIZE
OF FIXTURES
PRV REQUIRED
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OWNER,��ONTRACTOR RESPONSIBLE FOR E�OSION CONTROUDRAINAGE
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PROPERTY TAX ACCOUNT PARCEL NO.
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PROPOSED SETBACKS (FT.)
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ALLOWED PROPOSED
FRONT SIDE REAR
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ADDITION
1:1
COMMERCIAL
1:1
COMPLIANCE OR
CHANGE OF USE
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1:1 MIXED USE
REMODEL
PARKING
REQ'D PROVIDED
LOT AREA
PLANNING REVIEWED BY DATE
1:1 MULTIFAMILY
SIGN
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CYDS
FENCE
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REMARKS
0 DEMOLISH
0 TANK
OTHER
GARAGE
ED RETAINING WALL
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FIRE SPRINKLER
CARPORT
ROCKERY
FIREALARM
ITYPE OF USE BUSINESS O"CTIVITY) EXPLAIN:
TYPE OF C7§`TRUCTION ;PE
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GROUP
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REMARKS
GEOTECH REPORT
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STRUCTURAL DESIGN
BY:
VALUATION
Description
Plan Check
HEAT SOURCE
LOTSLOPE%
VESTED DATE
Building Permit
PLAN CHECK 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
SEPARATE PERMISSION.
Grading
Engr. Review
2
PERMIT APPLICATION: SEE ECDC 19.00,005(A)(5)
PERMIT LIMIT: SEE ECDC 19,00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
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OAPPLiCANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
ININTE REST, 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
Fire Inspection
Landscapelnsp.
Recording Fee
Rec,
IJRMAT'ON
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
'GENT OF
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-
NIP Y
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
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IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
CALL
FOR INSPECTION
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(425)
771 -0220
SIGNATU (OWNER6R AGENTI
'71
DATE SIGNED
OCCUPANT,
LOAD
FEE Description
State Surcharge
City Surcharge_
Base Fee
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building official or his/her Deputy: and Fees are paid, and
/receipt is acknowledged in space provided
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ATTENTION AL IJJJ
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. UBC109 / IBC110 f IRC110. PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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