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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PROPERTY TAX ACCOUNT PARCEL NO.
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MIXED USE
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GRADING o FENCE
REPAIR CYDS X
El DEMOLISH 1:1 TANK
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CARPORT ROCKERY
FIRE
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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PERMIT EXPIRES
PERMIT
NUMBER
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ADDRESS
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PLAT NAME/SUB61VISION NO.
LOT NO
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LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OrFICIAL STREET MAP
TESCP Approved E3
13
RW Permit Required
Street use Permit Required 13
EXISTING
PROPOSED--
Inspection Required E3
Sidewalk Required
REQUIRED DEDICATION
FT
Underground
Witinq required E3
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 13 NO[3
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REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ENGINEERING REVIEWED BY DATE
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WAIVER 13 ALLOWED I PROPOSED ALLOWED , PROPOSED
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LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR
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PARKING. LOTAREA I PLANNING REVIEWED BY DATE
REQ1D I PROVIDED
F]T.) REMARKS
TYPE
OCCUPANT
GROUP
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SPECIAL INSPECTION
CONSULTANT
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DESCRIBE WORK TO BE DONE
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REMARKS
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GEOTECH REPORT
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STRUCTURAL DESIGN
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VALUATION
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Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE
LOTSLOPE%
VESTED DATE
Building Permit
City Surcharge
PLAN CHECK NO:
Plumbing
60
'Base Fee
6o
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Grading
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUI31C
DONMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
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PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
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PERMIT LIMIT., SEE ECDC 19.00.005(A)(6)
Fngr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
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Fire Review
Plan Chk. Deposit
Lid IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
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2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
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x 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
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Tota I Amt. Due Oki
0 NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
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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. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
CALL
Building Official or hisihor Deputy: and Fees are paid. and
IN VI ' OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt is acknowledged in space provided.
WORKMEN'S COMPENS;=_, URANCE AND RCW 18:27.
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LOLATION
SIGNATURE (OWNER AGE T): DATE SIGNED
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771-0220
DATE
RELEASEC�j
ATTENTION"��
EXT. 1333
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USE OROCCUPYA BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
ORIGINAL -FILE. YELLOW -INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 if IBC110 / IRC110.
PINK -OWNER -,GOLD - ASSESSOR
10104
PRESS HARD - YOU ARE MAKING 4 COPIES
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