20051005.pdfDATE REC
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILINGADDRESS
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CITY ZIP TELEPHONE
NAME
ADDRESS
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CITY ZIP
4114061'rillIze-
STATE LICENSE NUMBER
PROPERTY TAX ACCOUNT PAR=- NO --
NEW
ADDITION
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?,�D'IEMOLISH
GARAGE
CARPORT
(TYPE OF USE, E
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TELEPHONE
34 4 o. I �' � rg.
EXPIRATON DATE I
49
PERMIT EXPIRES L
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PERMIT
NUMBER IM
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JOB SUITEtAPT#
ADDRESS
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PLAT NAM EISUB DIVISION NO,
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LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPApproved
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E3
RVV Permit Required
Street use Permit Requited 13
EXISTING PROPOSED—
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nspectran Required
[3
REQUIRED DEDICA142!t. C"19?4 REQUIRED
dewalk Required
'underground
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CI
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METER SIT
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REMARKS P �OPERTY
OWNER/CONTRACTOR RESPONSIBLY" EROSION CONTROUDRAINAGE
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.WATER-MMR TO BE RRMCMDft
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RF13 ONLY
2- E14GINEEFWG Re INSPECnON DATE
4CA 11 GST ON BACK OF JOB C'
rux INSPECrnoN gE0jjjpp.A.,, A"
FIRE REVIEWED BY DATE W
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BY VARIANCE OR CU SHORELINE ORADBI I INSPECTIO SEPA
REO'D COMPLETED EXEMPT
D YES E3 No I I
CA# ZONE SIGN AREA HEIGHT
WAIVER 13 ALLOWED I PROPOSED ALLOW ED , PROPOSED
STUDY C1 I I I
,,2!q,jRESIDENTIAL
PLUMBI NG I MECH
LOT COVERAGE
REQUIRED SETBACKS (FT
ED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
UR SIDE REAR
COMMERCIAL
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COMPLIANCE OR
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MIXED (ISE
CHANGE OF USE
1
'2
PARKIN
LOTAREA
PLANNING REVIEWED BY DATE
5
1316
U MULTIFAMILY SIGN 1PROVIDEW
IGRADING FENCE
D CYOS 1:1 x FT.) REMARKS
TANK 13 OTHER
RETAINING WALL FIRE SPRINKLER
ROCKERY 1:1 FIREALARM
ORACTIVITY)EX AIN.
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TYPE OF= Co OCCUP
GROU�U"�Z,
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NUMBER NUMBER OF
OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
U IT
STORIES UNITS LOAD
DESCRIBE WORK TO BE DONE
REQUIRED LJ YES
REMARKS
GEOTECH REP&T
BY:
STRUCTURAL DESIGN
BY:
VALUATION
$
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Description
Plan Check
HEAT SOURCE
LOTSLOPE%
VESTED DATE
Building Permit
PLAN 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 PUBW,0
DOPMAIN (CURBS, SIDEWALKS. DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Grading
Engr. Review
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
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESS ORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT B E
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Fire Review
Fire Inspection
Landscape Insp.
Recording Fee
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
FEE Description
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
6
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FEE
P�P�-
APPLICATION APPROVAL
This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSIRUC. 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
Im wint ION OF THE ODE OF THE ST E OF WASHINGTON RELATING TO 9:#nD 1KIQD1=rTlr)KI recept is acknowledged in space provided
WORKMEW,I�COMPE I RANCE AND RCW 18:27. 0 1611,41
ER NT e: DATE SIGNED
SIGNAT (425)
771- ARCLEA
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0220 RELEA
ATTENTION EXT. 1333
IT IS UNLAWFUL QVSE 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 I ISC110 I IRC110.
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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ORIGINAL - FILE YELLOW - INSPECTOR
PINK -OWNER GOLD - ASSESSOR
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