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CITY OF EDMONDS h
CONSTRUCTION PERMIT APPLICATION J(
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ENSE NUMBER EXPIRATION DATE
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PROPERTY TAX ACCOUNT PARCEL NO.
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NEW E] RESIDENTIAL 1:1 PLUMBING MECH
AD . DITION El COMMERCIAL COMPLIANCE OR
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CHANGE OF USE
MIXED USE
REMODEL MULTIFAMILY 13 SIGN
GRADING FENCE,
REPAIR CYDS X 13�9 FT.)
DEMOLISH TANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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NUMBER
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NUMBER 0
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DESCRIBE WORK TO BE DONE
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VESTED DATE
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DOOE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT. SEE ECDC 19.00.005(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
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I EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
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
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
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'��ENSATION .PMRfNCE AND RCW 18:27.
DATE SIGNED
[)N7VRMEN�/
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ERMIT
IUMBER
113 SUITEIAPT#
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.AT NAM EiSUBDIVI SION NO
LOT NO
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LID NO.
LID FEE S
JBILIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required
Street Use Permit Required
<ISTING PROPOSED
inspection Roquired
Sidewalk Required
ZOUIRED DEDICATION FT
Underground
Wiring required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 13 NO13
EMARKS
WNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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NGINEERING REVIEWED BY DATE
117
IRE REVIEWED BY DATE
VARIANCE OR CU SHORELINEORADBO I INSPECTION01 SEPA
REQ'D COMPLETE EMPT
YES EI N
-0 L ZONE
SIGN AREA HEIGHT
VAIVER'A ALLOWED PROPOSED ALLOWED, PROPOSED
3TUDY 0 12�4 .2
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R(IDE, REAR
444b q 60 2,01 iOl 1b, 1&0,ko, / -3)Li' I
PARKING LOTAREA 1,,PLANINING3 REVIEWED BY DAW
REO'D PROVIDED I
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rtEMARKS
SPECIAL INSPECTION
REQUIRED 13YES
REMARKS .
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
LandscapeInsp.
Recordinq Fee
CONSULTANT
CALL
FOR INSPECTION
(425)
771 .0220
ATTENTION V 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-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 i IRC110.
OCCUPANT izz
GROUP
FEE Description
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt #
Total Amt . Due
I Receipt #
1 VIVO
APPLICATION APPROVAL
This application is nota permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided
Elcl S S N RE DATE
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