20050937.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved ❑
RW Permit Required ❑
Street Use Permit Required ❑
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OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE z
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ENGINEERING REVIEWED BY DATE
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U FIRE REVIEW DUbtain blectrical
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STATE LICENSE NUMBER EXPIRATION D E CH E ED BY VARIANCE "�•'
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to 17 YES 13 NO
CA# ZONE SIGN AREA HEIGHT
-t PROPERTY TAX ACCOUNT PARCEL NO.
WAIVER 13 ALLOWED PROPOSED ALLOWED PROPOSED
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Q O STUDY 13
❑ NEW RESIDENTIAL LUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
`y ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
❑ COMMERCIAL COMPLIANCE OR ?
❑ ADDITION1:1MIXED USE ❑ CHANGE OF USE z
❑ARLOT AREA PLANNING REVIEWED BY DATE
REMODEL ❑ MULTIFAMILY ❑ SIGN REO'DPROVIDED a
GRADING FENCE
❑ REPAIR ❑ CYDS ❑ ( X FT.) REMARKS
❑ DEMOLISH ❑ TANK ❑ OTHER
z ❑GARAGE FIRE
CARPORT ❑ ROCKERY RETAINING WALL ❑ FIREALARM SPRINKLER
(TYPE OF USE, BUSINESS OR ACTIVITY) EXP IN:
TYPEC NSTRUCT ON C E OCCUPANT
v GROUP
cNUMBER .� NUMBER OF
OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
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STORIES UNITS LOAD
0 REQUIRED 0 YES
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GEOTECH REPORT �
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Description FEE Description FEE
Plan Check Stale Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE �y
Building Permit City Surcharge itel U
PLAN CHECK NO: Plumbing Base Fee , CG
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanicalc2b
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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.)WILL REQUIRE Grading
t SEPARATE PERMISSION.
Engr. Review
Y PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
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 Plan Chk. Deposit
uj IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
f 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.'
Recording Fee Receipt #10
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 FOR INSPECTION
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO receipt is ac Howled led in space provided.
WORKMEN'S COMPENSATION RANCE AND RCW 16:27. C OFFI L9'S1GA4TU E D E
SIG A�Ty,URE( WNER GEN DATE SIGNED (425) J
(�(i�� VA 771w0220 RELEAS BY 0 E
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 a YELLOW • INSPECTOR.
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109 I IBC110 I IRC110. PINK -OWNER • GOLD • ASSESSOR
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