20050843.pdf7
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CONSTRUCTION PERMIT APPLICATION
-OWNER NAMEINAME
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CITY ZIP TELEPHONE
NAME
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STATE LICENSE NUMBER EXPIRATFN[A 9VECKED BY
PROPERTY TAX ACCOUNT PARCEL NO
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NEW
1:1 RESIDENTIAL
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ADDITION
COMMERCIAL
<IXED
USE
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
RETAINING WALL
CARPORT
ROCKERY
X
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAft
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NUMBER
NUM13ER OF
OF
DWELLING
STORIES
UNITS
1:1 PLUMBINGIMECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
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M OTHER
FIRE SPRINKLER
FIREALARM
MOM
PERMIT EXPIRES
PERMIT
NUMBER
JOB SUITEO,APT#
ADDRESS
PLAT NAMEISUBDIVISION NO.
LOT NO,
I
LID NO
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required
Street Use Permit Requited
EXISTING PROPOSED
inspection Requited
4
Sidewalk Required
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REQUIRED DEDICATION FT
Underground E3
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METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES13 NOM
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REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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ENGINEERING REVIEWED BY
FIRE REVIEWED BY DATE W
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VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
I REQ'D COMPLETED I EXEMPT
OYES ONO
CA# ZONE SIGN AREA HEIGHT
WAIVER 0 ALLOWED I PROPOSED ALLOWED , PROPOSED
STUDY 13
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR
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PARKING LOTAREA .1 PLANNING REVIEWED BY DATE I
REC'D PROVIDED
FT.) I REMARKS
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REQUIRED,8YES
DESCRIBE WORK TO BE DONE,., '73L�26
REMARKS
GEOTECH REPqRT
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VALUATION
Description
Plan Check
HEAT SOURCE
LOTSLOPE%
VESTED DATE
Building Permit
PLAN CHECK NO:
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Grading
Engr. Review
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
"APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
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 W E OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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NOR LIMIT IN ANY Wi4IHE CITY'S ABILITY TO ENFORCE ANY.ORDINANCE PROVISION.'
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
I HEREBY ACKNOWLEDGEItHAT 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. GR MPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
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hula E R
TION, i __I IN ING K AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
tTO
IN VIUL 10 F LA OR CODI OF THE STATE OF WASHINGTON RELATING T
4'P L OR CODE
FOR INSPECTION
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WOR T NCE AND RCW `18:27.
4
(425)
SIr E AG
DATE SIGNED
771-0220
OCCUPANT
GROUP
OCCUPANT
LOAD
FEE
Description
FEE
10-1
State Surcharge
City Surcharge
Base Fee
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Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APrRriVA- I
This application is not a pennit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided
Z R�i Sl?)RE DATE
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�K,A D BY DATE
N IOIV EXT. 1333
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IT IS UNIL UL 0 USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL L
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL - Fit F YELLOW - C40 R
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110. PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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