20051018.pdfDATE RECEIVE7 1 6
0, 1 1 PERMIT EXPIRES
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PERMIT
NUMBER
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PLAT NAMEISUBDIVISION NO.
LOT NO.
LID NO.
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LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required
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Street Use Pennil Required
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EXISTING PROPOSED
inspection Required
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Sidewalk Required
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REQUIRED DEDICATION FT
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ALLOWED PROPOSED
REQUIRED SETBACKS (FT)
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PROPOSED SETBACKS (FT.)
FRONT LIRSIDE REAR
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REMARKS
DEMOLISH El TANK OT7HER
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT El ROCKERY FIREALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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NUMBER
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VALUATION
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Description
FEE
Description
FEE
Plan Check
State Surcharge
HEALSOUR LOTSLOP
VIISTEKATI
Building Permit
City Surcharge
PLAK CHECK NO:
Plumbing
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT C - OVERS WORK TO
Grading
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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
J DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
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 SPOUSEi HEIRS, ASSIGN S AND SUCCESSORS Fire Review Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARM LESS THE CITY OF
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 Landscapelnsp. Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
Recording Fee Receipt # 9j 5-1
1 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 receipt acknowled ed in space provided
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING To FOR INSPECTION
WORKMEN'S COMP NSAT W 18:27.
E ��NSURANCE AND RC SI DATE
SIGNATU91E (OWNER 0 GE )y DA F (425)
WTEIGNED
4, zi RELEASN Bi ATE
771 0220
At1tNTION 30,
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 kS'PEITOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 I IRC110. PINK -OWNER GOLD - ASSESSOR
110/04 PRESS HARD - YOU ARE MAKING 4 COPIES
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