20050920.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PLAT NAMEISUBDIVISION NO.
LOT NO
LID NO
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved CI
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R01 Permit Required
Street use Permit Required 0
EXISTING PROPOSED
Inspection Requited C3
Sidawalk Required El
REQUIRED DEDICATION FT unaergirwrid C1
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METER SIZE L114E SIZE NO. OF FIXTURES PRV REQUIRED
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STATE LICENSE NUMBER EXPIRATION DATE
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PROPERTY TAX ACCOUNT PARCEL NO.
7/ 6
NEW RESIDENTIAL PLUMBING / MECH
COMMERCIAL x
ADDITION COMPLIANCE OR
MIXED USE r_1 CHANGE OF USE
REMODEL 1:1 MULTIFAMILY 1:1 SIGN
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ALLOWED PROPOSED
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
FRONT URSIDE REAR
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REO'D PROVIDED
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PLANNING REVIEWED BY DATE
GRADING c FENCE
REPAIR 1:3 YDS' 1:1 x FT.)
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REMARKS
DEMOLISH 1:1 TANK 0 OTHER
GARAGE Ei RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY 0 FIRE ALARM
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(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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COD PANT
GORCCUP
NUMBER
OF
STORIES
NUMBER OF
DWELLING
UNIT
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CONSULTANT
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DESCRIBE WORK T(5 BE DONE
REMARKS
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_z Description
P I C
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F Building Permit
PLA I N 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 Grading
SEPARATE PERMISSION.
2 Engr. Review
M PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
W
CL PERMIT LIMIT:SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review
uj IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
0_j DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp.
01 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Recording Fee I
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- CALL
TION; AND 114 DOING THE WOk AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF TH E OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
.COMP
EN: LA
WORKMEN" ONIN ANCE AND RCW 18:27.
SIGN E (OWNER LtENTI/ DATE SIGNER
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—71 771-0220
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FEE Description
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or hisiher Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
RE DATEI
& Aj 1.6116
AtTtNTION 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-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC1110 I IRC110.
10/04 PRESS HARD - YOU ARE MAKING 4 COPIES
UGINAL - FILE YELLOW - INSPECTOR
PINK -OWNER GOLD - ASSESSOR
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