20050874 (2).pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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NAME
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PLAT NAME/SUBDIVISION NO. f LOT NO. LID NO.
LID FEE 5
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApproved O
RW Permit Requited E3
Street Use Permit Required E3
EXISTING PROPOSED Inspection Required 0
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STATE LICENSE NUMBER EXPIRATI N DATE CTV
VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
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STATE LICENSE NUMBER EXPIRAT&N DATE C• OYES D NO
PROPERTY TAX ACCOUNT PARCEL NO. CA# ZONE SIGN AREA HEIGHT
Q /, WAIVER 13 ALLOWED PROPOSED ALLOWED PROPOSED
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❑ NEW ESIDENTIAL PLUMBIN/ MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR t
COMMERCIAL COMPLIANCE OR
❑ ADDITION ❑
MIXED USE CHANGE OF USE i
❑❑ SIGN REO'D ARPIROVIDED LOT AREA PLANNING REVIEWED BY DATE
REMODEL MULTIFAMILY
FENCE
❑ REPAIR GRADING CYDS ❑ ( X FT.) REMARKS
❑ DEMOLISH ❑ TANK ❑ .OTHER
z ❑ GARAGE CARPORT 13RKIERY NING WALL ❑ FIRE ALARM FIRE LER
P: (TYPE OF USE, BUSINESS QR ACTIVIJY) EXPLAI A _
NUMBER NUMBER OF
OF DWELLING SPECIAL INSPECTION CONSULTANT OCCU
j .STORIES - UN TS - LOAD
s REQUIRED D YES -
DESCRIBE WORK TO BE DONE
REMARKS
/ `'� `/ �i GEOTECH REPORT
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STRUCTURAL DESIGN
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:J6 CA" ItLJL Description FEE Description FEE
Plan Check State Surcharge
HEAT SOUR E LOT SLOPE% VESTED DATE
Building Permit City Surcharge zo
PLAN ECK 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
: DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
w PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
CL PERMIT LIMIT: SEE ECDC 19,00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection
eN) *APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
Lu IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
C EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection LReceipt#
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
= FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE
CDEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE LandscapeInsp. t. Due
= 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 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- CALLBuilding Official or his/her Deputy: and Foes are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATI HE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION r pt is acknowledged In space provided.
WORKME S TION INSURANCE AND RCW 18:27,
FICIAL I ATU _ DA
SIGN NER %T1, DATE SIf ED I;4aS) 6S
09 "'le�'� 771-OZ2O R EA D DA
ATTENTION I 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- IGwni -Flip •YELLOW -INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109 / IBC110 7 IRC110. PINK - OWNER • GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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