20050191.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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NUMBER 7_31 C
JOB SUIT4;APT#
ADDRESS
PLAT NAMEISUBDIVISION NO, LOT NO LID NO,
I I I LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING PROPOSED
2.20 REQUIRED DEDICATION — FT
I METER SIZE I LINE SIZE 1 140. OF FIXTURES
REMARKS
OWNERICO
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. ESCP Approved
L3
RW Permit Required
13
Streql Use Permit Recoved
13
Inspection Requited
13
Sorvvalk Required
13
Undotgtound
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Wilifiq required
13
PRV REQUIRED
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NEERING REVIEWED BY
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FIRE REVII WED BY DATE""
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COMPLETE b EXEMPT
CA# ZONE SIGN AREA HEIGHT -
WAIVER OPOSED ALLOWED PROPOSED
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LOTCOVERAGE Mff ^11loan SETBACKS IFT PROPOSED SETBACKS (FT.)
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PLUMBING / MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
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PARKING LOTAREA PLANNING REVIEWED BY DATE
SIGN REQ'D I PROVIDED
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FIRE SPRINKLER
FIREALARM 11
NUMBER
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NUMBER OF
DWELLING
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SPECIAL INSPECTION
STORIES
UNITS
REQUIRED DYES
DESCRIBE WORKTO BE DONE
REMARKS
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
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Description
Plan Check
HE,5T SOURCE
LOT SLOPE56'
VESTED DATE
6/4 j
Building Permit
PLA14 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
Grading
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDC 119.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
Fire Review
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
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
Landscapeinsp.
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION ' -
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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
PE-7 OCCUPANT
GROUP
CONSULTANT OCCUPANT
I LOAD
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
EMPLOYEDJ CALL
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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 COMPENS���URANCE AND RCW 113:27.
SIGNA�PE(OWNER;(!!!�6 Tj):),0. DATEPIGN§0 (425)
C �1 3 w6. 771
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A TKNTION 0411F 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 I IRC110-
FEE Description FEE
State Surcharge
City Surcharge
Base Fee 0 r)
Plan Chk. Deposit
Receipt H
Total Amt. Due
1 Receipt # "Cp- I
APPLICATION APPROVAL
This application is riot a permit until signed by the
Building Official or his/tier Driputy� and Foes are Paid. and
receipt is acknowledged in space provided
DATE
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�E`LEASED BY, DATE
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ORIGINAL -FILE YELLOW -INSPECTOR
PINK -OWNER GOLD - ASSESSOR
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