20050754.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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a PROPERTY TAX ACCOUNT PARCEL NO.
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❑ NEW❑/RESIDENTIAL ❑ PLUMBINGIMECH
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ADDITION �r� MIXED USE ElCHANGE OF USE
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❑ REMODEL ❑ MULTIFAMILY ❑ SIGN
1:1 REPAIR ❑ GRADING ❑ FENCE
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❑ DEMOLISH ❑ TANK %%9GARAGE RETAINING FIRE SPRINK
z ❑ CARPORT ❑ ROCKERY WALL ❑ FIRE ALARM LER
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PIAT NAMEISUBDIDII--VISION NO. LOT Nd LID NO,
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApproied O
RW Permit Required E3
Street Use Permit Requited E3
EXISTING 'PROPOSED Inspection Required O
Sidewalk Required V
REQUIRED DEDICATION FT Underground O
----- ---I Wamg required 13
METER SIZE LINE SIZE NO. OF FIXTURES I PRV REQUIRED,
YES 13 NO [3 z
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REMARKS W
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE z
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ENGINEERING REVIEWED
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NCE ORI SHORELINE OR ADB# INSPECTION SEPA
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ZONE SIGN AREA HEIGHT
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O /� COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ED PROPOSED FRONT IDE REAR FRONT U SIDE REAR
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//PA�R��KIN�G)// LOT'AREA PLANNING R��IEW�DB0 PROVIDED
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OFL DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
STORIES 1 UNITS LOAD
DESCRIBE WORK TO BE DONE. REQUIRED 13 YES
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1 STRUCTURAL DESIGN
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Description FEE Description FEE
Plan Check State Surcharge �-
HEAT SOURCE LOT SLOPE% VESTED DATE /
Building Permit City Surcharge
PLAN CHECK NO:� 0 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
f DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
u PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5) Engr. Review
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) En r.
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr.
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*APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
rt EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
_ FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE f �!
D DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due
= NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee Receipt # L L
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER, 1 AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application Is not a permit until signed the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or nowl Deputy: and Fees are p paid, and
IN VIOLATION OF THE LABO CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATI RANCE AND RCW 18:27,
O ISIG RE DATE
SIGNATUFIFj�(OWNER OVGE, DATE SIGNED (425)
0213 771 m0220 RELEASED BY DATE
ATTENTION EXT. 1333 �J/�
IT UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL '/G•.�
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL -FILE YELLOW - INSPE OR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109I IBC110 / IRC110. PINK -OWNER GOLD ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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