20050358.pdfjjDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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ERMIT
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PLAT NAME/SUBDIVISION NO. l/ILOTtNNO. LID NO.
LID FEE 5
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved O
RW Permit Required 0
Street Use Permit Required 13
EXISTING PROPOSED Inspection Required E3
Sidowalk Required E3
REQUIRED DEDICATION FT undergroJnd O
Wirino ro wmd 13
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES D NOD Z
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REMARKS w
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE z
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FIRE REVIEWED BY DATE W
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TATE PLICENSE NUMBER EXPIRATION DATE BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
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Q PROPERTY TAX ACCOUNT PARCEL NO. CA# ZONE SIGN AREA HEIGHT
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NEW Q RESIDENTIAL PLUMBING? MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR c7
ADDITION 1:1 COMPLIANCE COMPLIANCE OR =
MIXED USE 1:1 CHANGE OF USE
REMODEL PARKING LOTAREA PLANNING REVIEWED BY DATE g
MULTIFAMILY 1:1 SIGN REVD PROVIDED _
(�0 GRADING ❑ FENCE NL
Y—"REPAIR CYDS ( X FT.) REMARKS
DEMOLISH 0 TANK
OTHER RC. IiLGc C IAl✓Yl %! �rh, j.lr.� tiVo1�(S
❑ GARAGE❑ RETAINING WALL ❑ FIRE SPRINKLER L� � 1 �% 1 -
Z CARPORT ROCKERY FIRE ALARM
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F (TYPE OF USE, BUSINES R ACTIVIT EX N:
a TYPE OF CQUEgUCTION CODE OCCUPANT
GRO 1 1
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m OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT ;
0STORIES UNITS LOAD
REQUIRED YES
DESCRIBE WORK TO BE DONE
REMARKS O
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STRUCTURAL DESIGN
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$�60
Description FEE Description FEE
Plan. Check 005 State Surcharge L
HEAT SOURCE LOTS LOPE% VESTED DATE
Building Permit `%j City Surcharge
PLAN CHECK NO: Plumbing
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Base Fee J
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
t BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBIC
i DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC,) WILL REQUIRE Grading
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t SEPARATE PERMISSION.
Engr. Review
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PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
o PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection
BACK OF PINK PERMIT FOR MORE INFORMATION
w 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
W 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 #
s ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE n
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due
= NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT 1 AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER, 1 AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATI RANCE AND RCW 18:27,
OFFICIALS SIGNATURE DATE
SIG A URE (OWNER O GENT DATE SIGNED (425)
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771 M022� RELEASED BY A
ATTEN ION EXT. 1333 I �(
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- oRlc!N L - FI YELLOW - INSPEC R
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109 I IBC110 I IRC1100 PINK ER •GOLD - ASSESSOR
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