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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINE
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FLAT NAME/SUBDIVISION NO. LOT NO. LID NO,
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved
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Street Use Permit Required 13
EXISTING E Inspection Requited CI
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METER SIZE UIRED
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ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY
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EXPIRATION DAIE
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ALL( iWED PROPOSED
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PROPOSED SETBACKS (FT.)
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FRONT SIDE REAR
FRONT LJR SIDE REAR
COMMERCIAL COMPLIANCE OR
ADDITION 1:1
El OF USE
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MIXED USE CHANGE
REMODEL El
PARKING
REO'D PROVIDED
LOT AREA
PLANNING REVIEWED BY DATE
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GRADING FENCE
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REMARKS
DEMOLISH 1:1 TANK Ei OTHER
GARAGE Ei RETAINING WALL FIRE SPRINKLER
FIRE ALARM
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CARPORT ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN.
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NUMBER NUMBER OF
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SPECIAL INSPECTION
CONSULTANT
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STORIES UNITS
REQUIRED 13 YES
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
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GEOTECH REPORT
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STRUCTURAL DESIGN
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Description
FEE
Description
FEE
Plan Check
State Surcharge
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LOT SLOPE%
VESTED DATE
Building Permit
City Surcharge
PLAI�CiIECIK NO:
Plumbing*
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Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Grading
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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
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DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
Engr. Review
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SEPARATE PERMISSION.
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PERMIT APPLICATION: SEE ECDC 19.00�005(A)1[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 Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HAR MILESS THE CITY OF
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2 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 Landscape Insp. Total Amt. Due
01 NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
34
Recording Fee I Receipt # 1
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF This application is not a permit 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 receipt is acknowled Led in spate provided.
IN VIOLATION OF THE LABOJI_f�CDE OF THE STATE OF WASHINGTON RELATING To FOR INSPECTION
WORKMEN'S COMPENS SUI%NCE AND RCW 18:27. lCI IG RE DATE
61': ATURE (OW NEFth"GENT) DATE SIGNED (425) Ct
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771-0220 RELE DBY DATE
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- ORIGINAL FILE YELLOW - INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC.110 / IRC110. PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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RECORD OF INSPECTIONS
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