20050291.pdfFDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
CITY ZIP TELEPHONE
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NAME
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PERMIT EXPIRES_-
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NUMBER Z'
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ADDRESS L) A-v E"- 1/0
PLAT NAM EISUB DIVISION NO.
LOI NO.
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LID NO,
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approied
E3
E3
RW Pernin Requited
13
EXISTING PROPOSED
Sueni Use Pemtt Requited
h5pitcliun Requited
13
Sidewalk Required
E3
REQUIRED DEDICATION FT
Undefgrmnd
Witing required
E3
13
METER SIZE
LINE SIZE
NO OF FIXTURES
_PRVREOUIRED
YES rl No 13
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REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE W
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STATE LICENSE NU EXPIRATION DATE
BY
VARIANCE OR CU
SHORELINE RADB4
INSPECTION
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COMPLETED I EXEMPT
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SIGN AREA
HEIGHT
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PROPERTY TAX ACCbI1NT PARCEL N6.
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WAIVER 13
ALLOWED PROPOSED
ALLOWED PROPOSED
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STUDY 13
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NEW ��RESIDENTIAL LUMBING MECH
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7f
LOT COVERAGE
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ALLOWED PROPOSED
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
FRONT URSIDE REAR
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ADDITION COMMERCIAL COMPLIANCE OR
MIXED USE CHANGE OF USE
MODEL
PARKING
REO'D PROVI DE4D
TAREA
LOT
PLANNING REVIEWED BY DATE
MULTIFAMILY SIGN
GRADING Ei FENCE
REPAIR CYDS x FT)
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REMARKS
DEMOLISH TANK E] OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT
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ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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TYPE OF CO"UCTION
CODE
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OCCUPANT
GROUP
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P5
NUMBER
NUMBE ROF
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OF
STORIES b
DWELLING
UNITS
SPECIAL INSPECTION
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CONSULTANT
OCCUPANT
LOAD
DESCRIB
REQUIRED YES
REMARKS
GEOTECH REPORT
BY:
STRUCA�GN
4
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BY: 11
VALUATION
$
K000
Description
Plan Check
HEAT SOURCE
LOTSLOPE%
VESTED DATE
Building Permit
P�ON CHECK NO: C7
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Grading
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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
W
III.
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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2
OAPPLICANT, 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 Be
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMA`fION
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
CALL
FOR INSPECTION
WORKMEN'S C2WY__NSATION INSURANCE AND RCW 18:27.
(425)
RAGENT):
DATE SIGNED
%IGNAITUREWLNER
t;i
771-0220
ATTENTION XT. 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.
FEE Description FEE
State Surcharge 0
City Surcharge
Base Fee
PlanChk.Deposit 1�
. ja��
Receipt #
Total Amt. Due
Receipt #
APPLICATION AP VAL
This application is not a permit until signed by the
Building Official or hisihor Deputy: and Fees are paid. and
receipt is acknowledged in space provided.
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