20050921.pdfFDATE RECEIVE�
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OW4NER NAM
41NAME OF BUSINESS
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MAILING ADDRESS
CITY ZIP TELEPHONE
P-N I/V—) I I PERMIT EXPIRES "r
P5,RMIT
NUMBER 0q
JOB
ADDRESS
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PLAT NAMEISUB DIVISION NO
LOT NO.
LID NO
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING PROPOSED
LID FEE S
TESCP Approvea
RW Permit Requirid
Street Use Permit Required
InspochoR Required
REQUIRED DEDICATION FT
Siae*A Required U
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Mine required
NAME
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ENGINEERIN G REVIEWED BY DATE
FIRE REVIEWED BY DATE W
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NUM EXPIRATION DATE
STATE LICENSE IL
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SHORELINE ORADBII
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REQ'D
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STUDY 13
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SIGN AREA
ALLOWED , PROPOSED
HEIGHT
ALLOWED PROPOSED
PROPERTY TAX ��CCOUNT PARCEL NO.
NEW RESIDENTIAL PLUMBING / MECH
ADDITION COMMERCIAL COMPLIANCE OR
MIXED USE CHANGE OF USE
REMODEL MULTIFAMILY SIGN
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR.
PROPOSED SETBACKS (FT.)
FRONT L/R SIDE REAR 0
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PARKING
REO'D OVIDED
LOT AREA
PLANNING REVIEWED BY DATE
GRADING FENCE
11 REPAIR E] CYOS X FT.)
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REMARKS
DEMOLISH TANK OTHER
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GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIREALARM
(TYPE OF USE BUS""r SS OR ACTIV ITY) EXPLAIN:
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NUMBER
OF
STORIES 69�5e_,�_
NUMBER OF
DWELLING
SPECIAL INSPECTION
REQUIRED 13YES
CONSULTANT
OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE
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STRUCTURAL DESIGN
BY:
VALUATION
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Desic.ription
FEE
Description
FEE
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Plan Check
State Surcharge
HEAT SOURCEI
--I L6T SLOPE%/
VESTED DATE
Building Permit
City Surcharge
PLAN CHECK NO:
Plumbing
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
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
2
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
A 'APPL S
V) ICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSOR
Fire Review
Plan Chk. Deposit
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
-A
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
LandscapeInsp.
Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
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Recording Fee
Receipt #
1 6(7 q
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-
APPLICATION APPROVAL
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT; AND T14AT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
This application is not a porrinit 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 THE LA ODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt is acknowledged i j space provided
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OF LS' NATU
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WORKMEN'S COMPENSAj� N �IUADINCE AND RCW 18:27.
lel\ I
SIGN RE (OWNER OR EN
DATE SIGNED
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-0220 4ATE
771 RELE
14T�E;iNTION 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 / IBC110 / IRC110. PINK -OWNER GOLD - ASSESSOR
10/04 PRESS HARD - YOU ARE MAKING 4 COPIES
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