20050928.pdfDATE RECEIVED
PERMIT EXPIRES
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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STATE LICENSE NUMBER RATION DATE
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PROPERTYTAXAC 0 NTPARCE NO.
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NEW RESIDENTIAL 1:1 PLUMBING MECH
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GARAGE RETAINING WALL FIRE SPRINKLER
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CARPORT ROCKERY FIRE ALARM
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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
SEPARATE PERMISSION.
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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
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OAPPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
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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
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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
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NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
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-
TION: AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSAT�N W 18:27.
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DATE SIGNED
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NUMBER
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LAT NAMEISUBDIVISION NO.
LOT NO.
LID NO,
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LID FEE S
UBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPApproved
(3
RW Permit Required
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street Use Permit Required
XISTING PROPOSED
inspection Requited
Sidewalk Required
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REQUIRED DEDICATION —
FT
underground
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METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
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REMARKS
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OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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ENGINEERING REVIEWED BY DATE
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V/RIANCE OR 6U StAELINE OR ADBO INSPECTION SEPA
REO'D 01 COMPLETED I EXEMPT
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ZONE SIGN AREA HEIGH
NAIVER13 ALLOWED , PROPOS ED ALLOWED I P OPOSED
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LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR
PARKING LOT AREA PLANNING REVIEWED BY DATE
REO'D . PROVIDED I I IL
REMARKS
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CODE
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SPECIAL INSPECTION
REQUIRED 13,
CONSULTANT
REMARKS
GEOTECH REPORT
BY:
STRUCTURAL DESIGN.
BY:
VALUATION
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Description
FEE
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
OCCUPANT
GROUP
OCCUPANT
LOAD .1�
Description
State Surcharge
City Surcharge
Base Fee
FEE
Fire Review Plan Chk. Deposit
Fire Inspection Receipt #
LandscapeInsp. Total Amt. DueZ VP
Recording Fee Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
CALL Building Official or hisihor Deputy- and Fees are paid. and
FOR INSPECTION receipt is acknowledged in space provided
SIG URE DA E
(425)
771-0220 R ASED BY _____[DATY
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 - INSPECT�
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1091 IBC110 / IRC1110. PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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