20050559.pdfC_
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
NAMEINA E OF BP
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CITY ZIP
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S TA
TE LICENSE NUMBER
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PROPERTY TAX ACCOUNT PARCEL NO.
PERMIT
NUMBER
JOB
PERMIT EXPIRES
LSUITEIAPT#
PLAT NAMEISUBDIVISION NO.
LOT NO.
I
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required
Street Use Permit Required
EXISTING PROPOSED
Inspection Required
Sidewalk Required
REQUIRED DEDICATION FT
Underground
Wiring required
METER SIZE
LINE SIZE
OF FIXTURES
PRV REQUIRED
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YES 13 NOO
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDIRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
VARIANCE OR CU SHORELINE OR ADE# INSPECTION SEPA
REO'D COMPLETED EXEMPT
OYES 13NO
CA# ZONE SIGN AREA HEIGHT
PROPOSEID
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WAIVER U
STUDY E3
ALLOWED
PROPOSED
ALLOWED
NEW
El ADDI TION
F1 RESIDENTIAL
COMMERCIAL
MIXED USE
PLUMBINA4L!S�;)`
COMPLIANCE OR
CHANGE OF USE
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT)
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
FRONT URSIDE REAR 13
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12
PARKING
LOTAREA
PLANNING REVIEWED 13Y DATE :5
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REMODEL
REPAIR
DEMOLISH
GARAGE
CARPORT
MULTIFAMILY
GRADING
CYDS
TANK
RETAINING WALL
ROCKERY
SIGN
FENCE
( X FT.)
OTHER
FIRE SPRINKLER
FIRE ALARM
R I EQD
PROVIDED
REMARKS
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NUMBER
NUMBEI
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OF
DWELL:
ECIAL I�SPECTION
CONS ULTANT
OCCUPANT
111
0
STORIES
UNITS
REQUIRED 13YES
LOAD
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REMARKS
GEOTECH REPORT
BY:
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STRUCTURAL DESIGN
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BY:
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
Base Fee
Mechanical
0
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Grading
BE DONE.ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
9
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
I-
i
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDd 19.00.005(A)(5)
Engr. Inspection
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
Fire Review
Plan Chk. Deposit
W IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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12: SHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
'S
Fire Inspection
Receipt #
ALL CLAII FOR DAMAGES OF WHATEVER NATURE, ARIS ING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
13 E
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANC
Landscapeinsp.
Total Amt. Due
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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
Thisapplication is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
Building Official of nis/ner Deputy'and Foosare 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
(eceipt if. acknowledged in space provided
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
OFFICIALS SIGNATURF DATE,
SIG WNE A NT -DATE SIGNED
(425)
Ir
I
771-0220
R LE SE BY DAI
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-
ORIGI L F11 F YELLOW - IN! PECI 311
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1091 IBC110 / IRC110.
PIN -OWN -R GOLD - ASSESSOR
10/04 PRESS HARD - YOU ARE MAKING 4 COPIES
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