20050552.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PERMIT EXPIRES
PERMIT
NUMBER �20 c/) S�— 0 I;S�,L�
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ADDRESS
PLAT NAME)SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPApptoved
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RW Permit Requited
Street use Permit Required
EXISTING PROPOSED
inspection Required
Sidewalk Required [3
REQUIRED DEDICATION FT
underground [3
Wiring required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 13 NO[3
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REMARKS
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OWNEWCONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
E14GINEERING REVIEWED
FIRE REVIEWED BY
DATE
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CHECKED BY VARIANCE OR CU SHORELINE ORADBO I INSPECTION SEPA
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WAIVEII� ALLOWED PROPOSED. ALLOW ROPOSEC
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NEW fq�RESIDENTIAL PLUMBING / MECH LOT ERAGE REQUIRED iSETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWECOVIROPOSED FRONT41DE REAR FRON Yj SIDE REAR
ADD COMMERCIAL COMPLIANCE OR
ITION MIXED USE CHANGE OF USE -7,
PARK G LOTAREA PLANNING REVIEWED BY DATE
REMODEL MULTIFAMILY SIGN REQ'D FIINIOVIDED
FENCE
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DEMOLISH TANK OTHER
RETAINING WALL
GARAGE FIRE SPRINKLER
CARPORT ROCKERY FIREALARM
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(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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NUMBER
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NUMBER OF
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UNITS
SPECIAL INSPECTION
REQUIRED 13YES
CONSULTANT OCCUPANT
LOAD
DESCRIBE WORK TO BE 4D 41E
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REMARKS
GEOTECH REPORT
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VALUATION
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Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE
LOTSLOPE%
VESTED DATE
Building Permit
I y Surcharge
Cit
PLAN CHECK NO -
Plumbing
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
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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 119.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
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'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 T14E 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
Plan Chk. Deposit
Fire Inspection
Receipt #
LandscapeInsp.
Total Amt. Due
Recording Be
Receipt #
1 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
APPLICATION APPROVAL
This application is not a perrinit until signed by the
CALL Building Official or his/her Deputy: and Fees are paid, and
FOR INSPECTION receipt is acknowledged in space provided
WORKMEN'S CO
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771-0220 DrIf
EKSE 13,17
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DATE Sl
ATTENTKIN
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL.
EXT. 1333 -1/i2k
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1091 IBC110 / IRC110.
O�IGINAL - FIL - ELLOW - INSPECTOR
PINK - OWNA)GOLD - ASSESSOR
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HNAL PROJECT APPROVAL FORM
TO:
DATE:
MEMOTO: PERMIT COORDINATOR, BUILDING DIVISION
Rom:. FIRE- DEPARTMENT DATE
PLEASE SICIN
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PLANNING DIVISION DATE
PLEASESIGN
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SITE ADDRESS 7� �50
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DESCRIPTIONOF WORK TO BE INSPECTED t1d.
A field inspection was conducted to determine compliance with -approved plans. Final approval
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denotes that there. are , no objections fro m the above signed Departm'ent to the, release of
PERFORMANCE BONDS and the granting of
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GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL wrFH CONDITIONS NOTED
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Copy of CONDITIONS given to own&/contrador by inspector.
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FAILED FINAL INSPECTION - OUTSTANDING. ISSUES
El Copy of CORRECTION NOTICE given to*owner/contractor by inpector
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RE -INSPECTED OUTSTANDING ISSUES -,GRANT FINAL PROJECT APPROVAL
Date Sigmiture
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