20050857.pdfj DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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[PERMIT EXPIRES
PERMIT
NUMBER
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ADDRESS
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PLAT NAM&SU B DIVISION NO
LOT N
LID NO
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LID FEE S I
PUBLIC RIGHT OF WAY PER OFFICIAL
EXISTING PROPOSED
STREET MAP
TESCP Approved
RW Pernia Required
Street Use Pornut Required (3
n5poclion Required
REQUIRED DEDICATION 0000"
FT
Sidewalk Required
Underground
Wiring tog ired
METER SIZ
Lill E SIZE
N FIXTURES
PRV REQUIRED
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YES C] NO E]
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Ir
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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FIRE REVIEWED BY DATE
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STATE LICENSE NUMBER EXPIRATION DATE CHECKED Y VARIANCE OR CU SHOREL
2�'= REQ'D COMFiLETED I EXEMPT
YES M
CAN SIGN AREA HEIGHT
PROPERTY TAXACCOUNT PARCEL NO. WAIVER ALLOWED I PROPOSED ALLOWED PROPOSED =n-
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LOT COVE PROPOSEDSET BACKS (FT.) 0 M
AGE REQUIRED SETBACKS (FT.)
�&NEW RESIDENTIAL PLUMBING I MECH ALLOWED P OPOSED FRONT SIDE REAR FRONT UR SIDE REAR C 0
COMMERCIAL 0
ADDITION D COMPLIANCE OR z 0
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El MIXED USE CHANGE OF USE z 0 C
PARKIN LOT AREA I PLANNING REVIEWED BY DATE
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El MULTIFAMILY SIGN REO'D PROVIDED X M
El REPAIR GRADING _� FENCE 7-- 1 -2- 1 0��f M Z
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(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN; 0 -n
TYPE OF,t�STRID);TION OCCUPAN A
GROUP
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NUMBER NU14SER OF /D x
OF DWELLING SPECIAL INKSPTEION CONSULTANT OCCUPANT M M
UNITS LOAD 0 -
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Description FEE Description FEE
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HEAT SOURCE VESTED DATE 0
PLAN CHECK NO: M
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
PERMIT APPLICATION: SEE ECDC 119.00.005(A)(5)
Engr. Inspection
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
"APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESSORS
Fire Review
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY A14D
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Fire Inspection
Landscapelnsp.
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
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION...
Recording Fee
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 OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
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
CALL
FOR INSPECTION
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
(425)
771-0220(
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DATE SIGNED
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Base ee
Plan Chk. Deposit
Receipt #
TotalAmt.Due.
Receipt N
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APP I I N AWK6VXL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided,
UT061ALS SIGN*111RE DATE
r
EXT. 1333
4
)44
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 4� 10
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
ORIGINAL -FILE - YELLOW - INSPEC4
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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MAINTAIN PLAT INSTALLED EROSION CONTROL
ALL EXPOSED SURFACES TO
BE COVERED WITHIN 2 DAYS Zone Corner NO Flag-h! 11
Setbacks Required ACtLial
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TO BE TIED INTO 1. 4 mw,
DETENTION SYSTEM
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COPY
Date:
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ADDRE55 XXXX 210TH FLAGE 5N.
LEOAL LOT 5, MADRONA GOVE
DE5GFZlf='TION:
SITE AREA: 6,2-7ci 5OUARE FEET
ZONINC PLANNED UNIT DEVELOPMENT
HEI(:5xHT GALGULATION (BA5EI:�> FROM EX15TIN6.7 &f;?-ADE)
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AVERAC
AGTUAL BUILDIN<� HEIOHT= 455.15,
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MAXIMUM BUILDINC-7 HEI<�,HT= 454.251
M
SURVEYOR TO PROVIDE. BENGHMARK MOST
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AFRC)PRIATE FOR HEI r-:;,HT VERIFIGATION)
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IMPERVIOUS AREAS
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RESM)ENGE NI 260C> souARE FEET
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GVRD PORGHES
DRIVENA--r5 460 SOUARE.FEET
200
PATIC)5 SOUARE FEET
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TOTAL 5,250 50UARE FEET
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LOT GOVERA&E
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LOT rO\/Ef;ZAr::,E IS F-3Ae)Er:;>.UFON'5596
PLANNED UNIT. DEVELOPMENT)
.2600 SOUARE FEET OF FF-OP05ED LOT GOVERAC
(INGLUDE5 STRUGTUREI GOVERED P ORGHE5, DEr-,<5 OVER 30")
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