20050888.pdfY
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DATE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNE NAME/NAME OF BUSINESS
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NAME
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PERMIT 01
NUMBER o
JOB SUITEIAPT#
ADDRESS �7
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LID FEE 5
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved Gl
RW Permit Required )7
Street Use Pernot Requited 0
EXISTING PROPOSED Inspection Required d
SitlewalkRequired
REQUIRED DEDICATION FT Underground C7
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METErI2r*��t�{� LINE SIZE A+ NO Ol.-I Elect 'cal FF FIXTURESM1 PP�RVV REQUIRED
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STATE LICENSE NUMBER EXPIRATI WTE
BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
r (� REO'D COMPLETED EXEMPT
3 0'0& Ll 13 YES I3 NO
CA# ZONE SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO.
00 I 6) 4�O . O � &0 O WAIVER13 ALLOWED PROPOSED ALLOWED PROPOSED
(11STUDY .13
RESIDENTIAL �pLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
— ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
COMMERCIAL COMPLIANCE OR _
❑ ADDITION ❑ CHANGE OF USE i
❑ MIXED USE PARKING LOT AREA PLANNING REVIEWED BY DATE g
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REQ'D PROVIDED
��/" GRADING FENCE
REPAIR ❑ CYOS ❑ ( X FT.) REMARKS
❑ DEMOLISH❑ TANK ❑ OTHER,
GARAGE RETAINING FIRE
❑ CARPORT ❑ ROCKERY WALL ❑ FIREALARM SPRINKLER
fTYPF OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER
OF
NUMBER OF
DWELLING
R OCCUPANT
GROUP �
CONSULTANT occu
p STORIES UNITS 11 1 LOAD
REQUIRED 1 YES
DESCRIBE WORK TO BE DONE
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1.VIDI �ion FEE Description FEE
Slate Surcharge
HEAT SQ CE LOT SLOPE% VESTED DATE r�
Building Permit City Surcharge
PLAN CHECK 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 Gradin
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g
t SEPARATE PERMISSION.
2 Engr. Review
w PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
IL 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 Fire Review Plan Chk. Deposit
ul IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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 ,
= NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.
11111111 1 Recording Fee Receipt #
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
IN VIOLATION OF ABO THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged In space provided.
WORKMEN'S PENSATI NCE A ICW 18:27,
OFFICIALS SIGNATURE DATE
SIGN AT E (OWNER OR DATE SI NED (425)
ry 1 D
771 =0220 RELEASED BY DA
ATTEN RTL
EXT. 1333
IT IS UNL 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 1 IBC110 I IRC110. PINK - OWNER • GOLD • ASSESSOR
10104 PRESS HARD = YOU ARE MAKING 4 COPIES
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