20050317.pdfCITY
1—., FDATE �RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PERMIT EXPIRES
PERMIT
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PLAT NAME/SUBDIVISION NO. LOT NO.
LID NO.
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LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
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RW Permit Required
street use Permit Roquirp.d
13
EXISTING PROPOSED
inspection Required
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Sidewalk Required
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REQUIRED DEDICATION FT
Undoirgtound
waing required
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METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 13 NO13
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REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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ALLOWED PROPOSED ALLOWED PROPOSED
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STUDY 13
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RESIDENTIAL PL UMBING / MECH
LOT COVE A E REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED P POSED FRONT SIDE REAR FRONT URSIDE REAR
ADDITION
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PLANNING REVIEWED BY DATE
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REPAIR CYDS 1:1 ( X FT.) REMARKS -
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GARAGE RETAINING WALL o FIRE SPRINKLER
CARPORT ROCKERY FIREALARM
(TYPE OF UkE, BUSINESS OR ACTIVITYJ IN:
Ty�- -I�ONSTR TION cc E OCCUPANI 1
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NUMBER OF
OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
NUMBER UNITS LOAD
STORIES REQUIRE[)
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Description FEE Description FEE
Plan Check State Surcharge
HETT F'SOURCE LOTSLOPE% 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
DONMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC i9.00.005(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 Plan Chk. Deposit
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
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 Landscapelnsp. Total Anit. Due D 5
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
I . Recording Fee Receipt 4 to
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF This application is not it ponnil until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC. CALL Building official or hisihor Deputy and Fees are paid. and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED receipt is acknowliulgod in space P(ovid0d
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEp;SoCO114�E N SAT ION IN RANCE AND RCW 10:27, S SIG folkilir DATE
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7�T(i WAG DATE SIJNED (425)
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771-0220 RE 'DU DATE
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ATTENTION 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 I IBC1110 / IRC110.
110)04 PRESS HARD - YOU ARE MAKING 4 COPIES
OF411-11NAL -FILE YELLOW INSPECTOR
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FINAL PROJECT APPROVAL FORM
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MEMO TO: PE 60 UILDING DIVISION
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FROM:
PA IR DEPARTMENT. DATE
PLEASFSIGN
DIVISION DATE
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PLEASE SIGN
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—PLANNING DIVISION DATE
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DESCRIPTION OF WORK TO BE INSPECTED-
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A field inspection was conducted to determine compliance with approved plans. Final approval denotes that
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there are objections from the above signed Department to the granting of
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approval of the described work
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—GRANT FINAL PROJECTAPPROVAL
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GRANT FINAL PROJECT APPROVAL WITH CONDITIONS NOTED
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—FAILED FINAL INSPECTION OUTSTANDING ISSUES
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—RE-INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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