20050665.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS ESlj r" /
MAILING ADDRESS A�
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CITY _ ZIP IIELEPHONE
ADDRESS'
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PERMIT EXPIRES✓, ?
PERMIT
NUMBER
JOB r SUITE)APT#
ADDRESS ,.,-.,.
PLAT NAME!SUBDIVISION NO. LOT NO. LID NO.
LID FEE 5
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP IESCP Approved ❑
RW Permit Required ❑
Street Use Permit Required ❑
EXISTING PROPOSED _ Inspection Requited ❑
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Sidewalk Requited
❑
REQUIRED DEDICATION FT Underground ❑
Weinrequired ❑
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES O NO O z
z
w
REMARKS w
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE z
O
z
W
3 ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE w
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BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
REO'D COMPLETED EXEMPT
O YES ONO
Q PROPERT,YLTAX AC/AC�ODUN.•T� PARCEL NO. % • / CA# _Q�— C1 ZONE SIGN AREA HEIGHT
J i �W� ���f/J �� �� STUDY ALLOWED PROPOSED ALLOWED PROPOSED
❑ NEW RESIDENTIAL ❑ PLUMBING I MECH LOT COVERAGE, REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR c7
❑ COMMERCIAL COMPLIANCE OR z
❑ ADDITION ❑ MIXED USE ❑ CHANGE OF USE E
❑ REMODEL❑ PARKING LOTAREA REVIEWED BY DATEMULTIFAMILY SIGN REQ'D PROVIDED
REPAIR ❑GRADING ❑ FENCE[PLANNING
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CYDS ( X FT.) REMARK
OTHER lly ANEO Or DEBRIS
DEMOLISH ❑ TANK ❑
GARAGE RETAINING WALL FIRE SPRINKLER MIIST BE CAPPED AT
z ❑ CARPORT El ROCKERY ❑ FIREALARM
d(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: r OPERTY LINE
E TYPE F N R $ STALLED n--
Lu NUMBER NUMBER OF
m OF DWELLING J. SPECIAL INSPEC3V CONSULTANT
p STORIES UNITS r REQUIRED l�(�M AT Al'PRVED DUPAI
DESCRIBE WORK TO BE DONE
REMARKS SEE DBMOLITIOti , NSP
SEON E OF JOB CARD&MOUnr4111"ll 1111T
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GEOTECH R OR
BY: R INSPECTION R
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STRUCTURAL DESIGN
/ BY:
VALUATION
$
Description FEE Description FEE
Plan Check Slate Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE Air
Building Permit G` City Surcharge `
PLAN CHECK NO: Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC Gradin
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g
i SEPARATE PERMISSION, Engr. R@VIEW
W PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
o PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) EngL Inspection
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
.jIN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
i EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
49
FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE , j
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT' OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due r
= NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
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, 1 AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• CALL Building Official or his/her Deputy: and Fees are 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 receipt is a knowlodged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27,
FV)11 7 RE DATE
SIGN U NER AGENT): DATE SIGNEDX425)r,
rGV r�� 771 -0220 RELEASED BY TE
ATTP ION EXT. 1333
IT IS UWCAWFUL TO USE OR OCCUPY A 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, UBC1091 IBC110 1 IRC1104 PINK -OWNER GOLD - ASSESSOR
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A Geld inspection was conducted to determine compliance with • approved plans. Final approval O mn
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denotes that there are no objections from the above signed Department ` to the release ' of
PERFORMANCE BONDS and the granting of: M m
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GRANT I+ INAL PROJECT APPROV AL �'
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GRANT PROJECT APPROVAL, WITH CONDITIONS NOTED
❑ Copy of CONDITIONS given to. owner/contractor by inspector, in
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
❑ Copy of CORRECTION NOTICE given to owner/contractor by inpector
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RE-INSPECTED OUTSTANUINC ISSUES - GRANT FINAL PROJECT APPROVAL f
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