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CITY OF EDMONDS N
CONSTRUCTION PERMIT APPLICATION ic
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PROPERTY TAX ACCOUNT PARCEL NO j
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NEW RESIDENTIAL PLUMBING / MECH
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GRADING FENCE
REPAIR CYDS X FT.). I
DEMOLISH TANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
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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
SEPARATE PERMISSION.
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PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
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PERMIT LIMIT., SEE ECDC 119.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
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IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
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FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
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DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
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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
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
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSAT19N
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SIGNATYF� (OWNEROR T'
DATE SIGNED
PERMIT EXPIRES
ERMIT
UMBER
SUITE/APT$$
DRESS r LI;7 '2,
AT NAMEISUBDIVI SION NO, I LOT NO. I 'CID 90�
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LID FEE S
)BLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
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RW Permit Required
street Use Permit Required
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CISTING PROPOSED
Inspection Required
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Sidewalk Required
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EQUIRED DE . DICATION FT
-underground
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C3
Waing requited
METER SIZE
LINE SIZE
FIXTURES
PRV REQUIRED
YES C3 NO 13
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��NER/CONTRACTOR RESPONS113LE FOR EROSION CONTROUDRAINAGE
NGINEERING REVIEWED BY DATE
REVIEWED BY DATE UJI
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VARIANCE OR CU SHORELINEORADBI J INSPECTION SEPA
REO ' D COMPLETED I EXEMPT
13YES 13NOI
AH ZONE SIGN AREA HEIGHT
�AIVER 13 ALLOVVED , PROPOSED AL LO'WED , PROPOSED
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LOT COVERAGE REQUIRED SETBACKS (FT.). PROPOSED SETBACKS (FT.).
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
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PARKING LOT AR LANNING REVIEWED BY DATE
REO'D PROVIDED
�EMARKS
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SPECIAL INSPECTION CON SULTANT LOOCACDUPANT
REQUIRE I
3EOTECH REPORTk_,
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STRUCTURAL DESIGN
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VALUATION
Description
FEE
Description
FEE,
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Base Fee
Mechanical
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Grading
Engr. Review
Engr. Inspection
Fire Review Plan Chk. Deposit
Fire Inspection Receipt #
Landscapeinsp. Total Amt. Due'
Recording Fee Receipt # 6101/
APPLICATION APPROVAL
This application is not a permit until signed by the
CALL Building Official or his/her Deputy: and Fees are paid, and
FOR INSPECTION receipt is acknowledged in space provided.
OFFICIALS SIGNATURE DATt
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(425) A\JL11, ls-at�x_ �Jbh
771-0220 D E
ATTENTION EXT. 1333 -7
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 1K
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- IGINA FIL - YELLOW INSPECTOR
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FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 I IBC110 / IRC1110. INK W R GOLD - ASSESSOR.
10104 PRESS HARD - YOU ARE MAKING 4 COP11
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