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CONSTRUCTION PERMIT APPLICATION JOB� SUITEIAPT#
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PLAT NAME/SUBDIVISION NO. LO NO. LID NO
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D , RW Permit Required 0
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CITY 710 TELEPHONE EXISTING PROPOSED Inspection Requited D
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NAME " METER SIZE LINE SIZE NO, OF FIXTURES PRV REQUIRED
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•/ OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE _
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❑ RESIDENTIAL %(PLUMBING MECH
COMMERCIAL COMPLIANCE OR
MIXED USE ❑ CHANGE OF USE
❑ ,MULTIFAMILY Q SIGN
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❑ CYDS ( X FT.)
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❑RETAINING WALL FIRE SPRINKLER
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COMPLETED I E% IAPT
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WAIVER 'ALLOWED PROPOSED ALLOWED PROPOSED
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LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
PARKING LOT AREA PLANNING REVIEWED BY DATE
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Building Permit _VMCity Surcharge 15
PLAN CHECK NO: Plumbing 071 6v Base Fee
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO McChanlCel
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC Gradin
9 DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g
SEPARATE PERMISSION,
Is Engr. Review
w PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
a PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engf. Inspection
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit P
� IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
r2 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 i ^�
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due (]
s 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 I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF This application Is not a permit until signed by the
THE OWNER. 1 AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building official or hislhor Deputy: and Fees are paid, and
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 FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27, OFFI 1 (GNAT DATE
SIGNATURE (OW ER A .ENT): DATE SIGNED /' (425)
� IV `� 771m0220 LEAS 13Y A
+ATENTION EXT. 1333
ITIS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 7/ r7 7
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGI I -FIE YELL • INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC1091 IBC110 I IRC110. PIN -ow ER GOLD -ASSESSOR
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