20050295.pdfo�-AFOATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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MAIUNG ADDRESS
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NAME
ADDRESS
CITY ZIP TELEPHONE
NAME
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PROPERTY TAX ACCOLff4T PARCEL NO.
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NEW
ADDITION
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REPAIR
DEMOLISH
GARAGE
CARPORT
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CHECKED BY
5 [PERMIT EXPIRES
PERMIT
NUMBER ag
JOB
ADDRESSOo 43
Wokl SUITEIAPTH
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PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
I
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required
Street Use Permit Required
EXISTING PROPOSED
Inspection Required
Sidewalk Required
REQUIRED DEDICATION
FT
Underground
Wninq faqwred
METER SIZE
LINE SIZE
0. OF FIXTURES
PRV REQUIRED
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YES13 NO13
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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ENGINEERING REVIEWED BY
LOT -Al
FIRE REVIEWED BY DATE Lu
VARIANCE OR CU I R LIN
REQ'D COMPLETED EXEMPT
13 YES 13 NO I
CA# ZONE S IGN AREA HEIGHT
WAIVER 0 ALLO �ED PROPOSED AL LOWED PROPOSED
STUDY 13 1 1 1 1 1
C7
RESIDENTIAL
COMMERCIAL
MIXED USE
PLUMBING/MECH
COMPLIANCE OR
CHANGE OF USE
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
t I
FRONT LIRSIDE REAR
12
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PARKING
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LOTA EA
PLANNING REVIEWED BY DATE
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_0 MULTIFAMILY
GRADING
CYDS
TANK
oRETAINING WALL
ROCKERY
Lj SIGN
FENCE
X FT.)
ME�
FIRE SPRINKLER
FIREALARM
REO D
PROVIDED
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REMARKS
-OR ACTIVIITY EXPLAIN
0PT;RUZT1 COD OCCUPAN
TYPE C P
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afl M I ROU
NUMBER NUMBER OF
OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
STORIES UNITS REQUIRED 13 LOAD
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REMARK!
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
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VALUATION
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Description
FEE
Description
FEE
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Plan Check
State Surcharge
HEAT SOURCE
LOT SLOPE%
VESTED DATE
Building Permit
City Surcharge
PLAN CHECK NO:
Plumbing
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAI i N (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 ANYWAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapeinsp.
Total Amt. Due
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT T HE 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-
kA UTHEORIZED THEREBY, NO PERSON WILL BE EMPLOYED
TION; AND IN DOING THE W�o
1:
IN VIOLATION OF THE L.6 I Do OF THE STATE OF WASHINGTON RELATING TO
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WORKMEN 'S COMPEN S4nO I URANCEANDRCW`18:27.
CALL
FOR INSPECTION
Z�PPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his1her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
)FFI I _-CrNATURA DATE
CIGNAT URE WINER A DAT IGNE91 (425)-
771-0220 -RE E
ATTENTION EXT. 1333
IT IS UNLAWFUL TO USE OR ( CCUPY A BUILDING OR STRUCTURE UNTIL L
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 f IRC110.
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
ORIGINAL -FILE YELLOW -INSPECTOR
PINK -OWNER GOLD - ASSESSOR
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