20050426.pdfDATE RECEIVED.
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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NUMBER NUMBER OF
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PERMIT
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ADDRESS
PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
I LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApproved 13
RW Permit Required [3
areet tnv�primiil Required 13
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WAIVER [3 ALLOWED I PROPOSED ALLOWED PROPOSED
STUDY 113 1 1 1
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT. SIDE REAR FRONT URSIDE REAR
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REMARKS
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GEOTECH REPORT
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VALUATION
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Description
Plan Check
HEAT SOURCE
LOT SLOPEOA,
VESTED DATE
Building Permit
HECK NO:
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WO RK 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
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 ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
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
OCCUPANT
GROUP
CONSULTANT OCCUPANT
1. 1 LOAD
THE OWNER. I AGREE TO COMPLY WITH CITY ANP STATE LAWS REGULATING CONSTRUC- CALL
TION; AND IN DOING THE WT H IFZEIDI EREBY. NO PERSON WILL BE EMPLOYED
Co�
)E�R
IN VIOLATIOX-PAJHE LA0 CO 0 T E STATE OF WASHINGTON RELATING TO FOR INSPECTION
,W SUI
WORKMEN�n= I SudANCE 4 CW 16:27.
SIGNATUP( NE dENT Ntv I
ENT// 1 (425)
7(1 771
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FEE Description FEE
State Surcharge
City Surcharge 1,�.cn
Base Fee c>
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt # g'3 * 7
APPLICATION APPROVAL
This application is not a pernnit until signed by the
Building Official or his/hor Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
FICIALS SIGNATURE R I , DATEI
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 / IBCi10 I IRC1110.
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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