20050135.pdfI
DATE RECEIVE?
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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MAILING ADDRESS
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CITY ZIP TELEPHONE C�
NAME
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ADDRESS
ZIP � TELEPHONE
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STATE LICENSE NUMBER
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EXPIF
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PROPERTY TAX.ACCOUNT PARCEL NO.
60 of/ _?6,9—U0
NEW
RESIDENTIAL
ADDITION
COMMERC I IAL
MIXED USE
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
0
DEMOLISH
E3
TANK
EGARAGE
3
CARPORT
11
RETAINING WALL
ROCKERY
(TYPE OF USE, BUSINE�"Ft ACTIVITY� EXPLAIN
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PERMIT
NUMBER
JOB ^UITE/APT#
ADDRESS
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PLAT NAMEJSU B DIVISION NO.
NO
LID NO.
L
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved 0
RW Permit Required E3
Street Use Permit Required E3
EXISTING PROPOSED
Inspection Required El
Sinowalk Required [3
REQUIRED DEDICATION FT
Underground 0
0
Wiring ruguifed
METER SIZE
LINE SIZE
NO OF FIXTURES
PRV REQUIRED
YES 13 No13 z
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REMARKS LU
OWNERJCONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE z
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ENGINEERING REVIEV)kj,I]Y,� jj.,0,44 U - " - DATE
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FIRE REVIEWED BY DATE Uj
:E1XBY VARIANCE OR CU SHORELINE ORADBII I INSPECTION SEPA
REO*D COMPLETED EXEMOT
�P CA# ZONE 13YES 13NO
SIGN AREA
OPOS HEIGHT
WAIVER13 ALLOWED I PR ED ALLOWED I PROPOSED
STUDY 13
PLUMBING if MECH
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
FRONT URSIDE REAR
129
COMPLIANCE OR
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CHANGE OF USE
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17-1
PARKING
LOTAREA
PLANNING REVIEWED BY DATE
IL
SIGN RED D PROVIDED
EiFENCE
( X FT.) REMARKS
OTHER
FIRE SPRINKLER
FIREALARM i
NUMBER
OF
STORIES
NUMBER 73F
DWELLING
UNITS
IV ( 4
"41
6 b4
SPECIAL INSPECTIO
REQUIRED 13YES
DESCRIBE WORK TO BE DONE
REMARKS
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GEOTECH REPORT
BY: %
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VALUATION
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Description
Plan Check
HEAT SOURCE
LOTSLOPE%
VESTED DATE
Building Permit
PLAN CHECK NO:
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS7ERMIT 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
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
'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
Fire Inspection
Landscapelnsp.
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
THEOWNER. 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 is COMPENSATIObLASWNCE AND RCW 18:27.
URE(OWNER( E T)�
DATE GNED (425),
MAd e_ L;R 116)__� 771-0220
A TENTION I// 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 / IBC110 / IRC110.
OCCUPANT
GROUP
OCCUPANT
LOAD
FEE Description FEE
State Surcharge
City Surcharge
Base Fee :::�A?
Plan Chk. Deposit
Receipt #
Total Amt. Due X
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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FiCIALS SIGNATURE DATE
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