20050823.pdfDATE RECEIVED
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PERMIT EXPIRES
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CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB UITEIAPTts
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PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
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STATE LICENSE NUMBER EXPIRATI E ED BY VARIANCE OR CU SHORELINEORADBI INSPECTION SEPA
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NEW ESIDENTIAL PLUMBING MECH LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
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PARKING LOT AREA PLANNING REVIEWED BY DATE
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GRADING FENCE I -
REPAIR 1:1 CYDS ( X FT.) REMARKS
DEMOLISH 1:1 TANK OTHER
GARAGE o RETAINING WALL FIRE SPRINKLER
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(TYPE OF USE, BUSINESS OR ACTIVIT Y) EXPLAIM TYPE ON T %OGE-) OCCUPANT 4�
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GEOTECH REPORT
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Description
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Plan Check
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VESTED DATE
Building Permit
PLAN tHECK NO:
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Grading
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
2
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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
Engr. Inspection
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W 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 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
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Fire Review
Fire Inspection
Landscapeinsp.
Recording Fee
CALL
FOR INSPECTION
(425)
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 OWNEW I AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRLIC-
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'S COMPENSATIOO RANCE AND RCW 18:27.
SIGNATYRE (OWNER OUGE 1:
DAT
FEE Description
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due oc
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Receipt # _10 k_):3
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or hisiher Deputy: and Fees arc paid, and
receipt is acknowledged in sppf.e provided.
S SFkATURE - ATE
A kAj �7n, Ij I d q11
771-0220
L EXT. 1333
AO N�TION
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.
10104 PRESS HARD -YOU ARE MAKING 4 COPIES
.114
ORIGINAL - FILE YELLOW - INSPECTOR
PINK -OWNER GOLD - ASSESSOR
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