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CITY OF EDMONDS Z
CONSTRUCTION PERMIT APPLICATION i
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STATE LICENSE NUMBER EXPIRATION DATE
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PROPERTY TAX ACCOUNT PARCEL NO. V
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NEW �§_R,ESIDENTIAL PLUMBING MECH
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GRADING o FENCE
REPAIR CYDS ( X FT)
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GLAZING %
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PLAN CHECK NO:
VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
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PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
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FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
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DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY C17Y ORDINANCE
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NOR LIMIT IN ANY WAY THE CITYs ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
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 LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENS RANCE AND RCW 18.27.
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PLAT NAME/SUBDIVISION NO. LID NO.
LID FEE S
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required
Street Use Permit Req'd
EXISTING — PROPOSED inspection Required
SidowalkRequired
REQUIRED DEDICATION— Fr Underground
Winng required
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
I I I YES13 NO. 13
REMARKS
OWNFR/CONTRACTOR RESPONSIBLE FOR EROSION CON1ROL/DRAINAGE
NGINEERING REVI15
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:IRE REVIEWED BY
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ALLOWED PROPOSED
ALLOWED PROPOSED
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LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (FF.)
tLLOWED PROPOSED
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FRONT UR SIDE REAR
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PLANNING REVIEWED BY DATE
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1EMARKS
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3PECIAL INSPECTION JAREA
REQUIRED YES
iEMARKS
)ROGRESS INSPECTIO1
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
OCCUPAN�
GROUP
OCCUPANT
LOAD
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PER UBC 108/FINAL INSPECTION REO'D
FEE Description
State Surcharge
j City Surcharge
Base Fee
FEE
Fire Review Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp. Total Amt. Due
Recording Fee Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
CALL Building Official or his/her Deputy; and Fees are paid, and
FOR INSPECTION receipt Is acknowledged In space provided.
OFFICIA SIG 7AJE tU D TE
(425) q
771-0220 RELEASED 16Y I b4ft—
ATTENTION E)ff 11333
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 - INSPECTOR
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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