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CITY OF EDMONDS
PERMIT
NUMBER
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CONSTRUCTION PERMIT APPLICATION
ADDRESS
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OWNER NAME/NAME OF BUSINESS
PLAT NAM EISUB DIVISION NO.
LO'T NO.
LID NO.
LID FEE S
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MAILING ADDRESS
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPApproved
RW Permit Required
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13
0
EXISTING PRopbsuD
Street Use Permit Required
inspection Required
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13
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CITY zip
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REQUIRED DEDICATION FT
Sidowat� Required
Underground
Wiring required
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NAME
METER SIZE LINE SIZE NO, OF FIXTURES
PRV REQUIRED
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REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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CITY ZIP TELEPHONE
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY
VARIANCE OR CU
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REQ'D. COMPLETE EXEMPT
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PROPERTY TAX A7'COUNT PARCEL NO. F
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ALLOW SED.1 ALLOWED ��6SED
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LOT COVERAGE REQUIRED SET13ACKS (FT.) PROPOSED SETBACKS (FT.)
FRONT URSIDE REAR
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ALLOWED PROPOSED
FRONT SIDE REAR
COMMERCIAL
ADDITION
13
COMPLIANCE OR
OF USE
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SIGN
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REQ'D PROVIDED
LOTAREA PLANNING REVIEWED BY DATE
ULTIFAMILY
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GRADING
REPAIR CYDS
1:1
FENCE
X FT.)
REMARKS
DEMOLISH TANK
1:1
OTHER
GARAGE RETAINING WALL
1:1
FIRE SPRINKLER
CARPORT ROCKERY
FIREALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
TYI�IE,& CONSTRUCTION OCCUPANT—
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NUMBER NUMBER OF
OF DWELLING
11 STORIEJ�&/ UNITS
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SPEKL I�SPECTION
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CONSULTANT OCCUPANT
LOAD
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DESCRIBE WORK TO BE DONE
REMARKS
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GEOTECH REPORT
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by:
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$
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE LOTSLOPE% VESTED DATE
Building Permit City Surcharge T6
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 Grading
DONMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION. Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005A)(5)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR H I ER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
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 CORRIECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF This application is not a pernut Until signed by the
THE OWNER. I 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 i cknowleaged in space provided.
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I�SI�GNATURCOW`NER R NT):� DATE SIGNED (425)
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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-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 It IBC110 f IRC1110.
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