20051004.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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MAILINGADDRESS
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NAME
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ADDRESS
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CITY
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DATE I CHECKED BY
PROPERTY TAX ACCOUNT PARCEL NO.
oo'517q ()000
12-00
NEW
RESIDENTIAL
PLUMBING i MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
MIXED USE
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
CYDs
FENCE
( X_
DEMOLISH
TANK
OTHER
GARAGE
CARPORT
RETAINING WALL
EYROCKERY
1:1
FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
10007(j
NUMBER
NUMBER OF
OF
DWELLING
STORIES
UNITS
DESCRIBE WORK TO BE DONE
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f`ERMIT
NUMBER ro
JOB
ADDRESS d?
PERMIT EXPIRES
,2
PLAT NAMEISUBDIVISION NO
LOT NO
LID NO .
I
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved 13
RW Permit Requirea M
Street Use Permit RLqueed 0
EXISTING PROPOSED
Inspection Required 13
sidewalk Requiled C3
REQUIRED DEDICATION FT
Undergiound E3
Winng riquacid [3
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 13 NO13
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REMARKS
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OWNER/CONTRACTOR RESPONS113LE FOR EROSION CONTROLIDRAINAGE
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4-
ENGINEERING REV15� LJ�1� ijjj DATE
FIRE REVIEWED BY DATE
VARIANCE OR CU SHORELINE ORADBO I INSPECTION SEPA
REO'D COMPLETED I EXEMPT
C1 YES 13 NO
CAII ZONE SIGN AREA I HEIGHT
WAIVER13 ALLOWED , PROPOSED ALLOWED , PROPOSED
STUDY 13 1 1
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED 'T SIDE REAR FRONT L/RSIDE REAR
EFORUO'N
jj/PLA N11,NGREV.1,EWEDBY DATE
NOW I I
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REMARKS AWATERI,717P'WE SHUTOFF
TYPE "ONST'
JUC
,a�� CA E
OCCUPANT
GROUP
SPEdIAL INSPECTION CONSULTANT OCCUPANT
R . EQUIRED LOAD
RE . MARKS In addition to the required
GEOTECH REPORT pressure/relief valve, an approved -
BY:
STRUCTURAL DESIVisted expunsilun tank sliall be
BY:
AM d on all hot water tanks.
VALUATION 0i"
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$ 1j _...
WeViription FEE
Plan Check
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'HEAT SOURCE LOT SLOPEO/6 VESTED DATE
/& 6 � t 116 Building Permit
PLAN CHECK NO: Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO J
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
E Engr. Review
r 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
Description FEE
State Surcharge
City Surcharge
Base Fee
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U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIR
U) S, ASSIGNS AND SUCCESSORS
Fire Review
Plan Chk. Deposit
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_j 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
x 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
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Recordin g 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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official or his/her Deputy* and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION- receipt is acknowledged in space provided
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
T U
0 LS SIGNh U E DATE
R ENT): DATE Sl NED
(425)
_�Ft
771-0220
f)ATE
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 -INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 if IRC110.
PINK -OWNER GOLD ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4
COPIES
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