20051030.pdfN
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DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
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CITY ZIP TELEPHONE
7AME
ADDRESS
TELEPHONE
NAME -1.1
CITY
ZIP TELEPHO14E
STATE LICENSE NUMBER
EXPIRATION DATE
CHECKED 9Y
PROPERTY TAX ACCOUNT PARCELNO.
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02rNEW
DYR'OESIDENTIAL
P I LUMBING / MECH
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ADDITION
M COMMERCIAL
COMPLIANCE OR
MIXED USE
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
CN DS
FENCE X j35 FT.)
DEMOLISH
TANK
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OTHER
GARAGE
o RETAINING WALL
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FIRE SPRINKLER
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CARPORT
ROCKERY
FIREALARM
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(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
/ I I PERMIT EXPIRES -._)Z Zlyoo",1 A,
PERMIT 1
NUMBER
JOB SSUl.T?E/APTP
ADDRESS
PLAT NAMEISUBDIVISION NO. LOT NO LID NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPApproved
L3
0
RW Permit Required
Street Use Permit Required
E3
EXISTING PROPOSED—
Inspection Required
E3
Souwalk Required
E3
REQUIRED DEDICATION FT
Underground
E3
E3
Witirm requited
METER SIZE LINE SIZE NO. OF FIX URES
PRV REQUIRED
YES E3 No E3
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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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FIRE REVIEWED BY DATE
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VARIANCE OR CU
SHORELINE RADB#
INSPECTION
SEPA
RECtD
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COMPLETED EXEMPT
OYES C1 NOI
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CA#
ZONE
SIGN AREA
HEIGHT
WAIVER 13
ALLOWED PROPOSED
ALLOWED ROPOSED
STUDY E3
LOT COVERAGE
REQUIRED SET13ACKS (FT.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT UR SIDE REAR
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PARKING
LOT AREA
PLANNING REVIEWED BY DATE
REQ'D I PROVIDED
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TYPE OF CONSTRUCTION
CODE
NUMBER
OF
NLP�BER OF
DWELLING
SPEdIAL INSPECTION
CONSULTANT
STORIES��Kj__r
UNITS
REQUIRED
DESCRIBE WORK TO BE DONE
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STRUCTURAL DESIGN
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BY:
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VALUATION
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Description
FEE
Plan Check
HEAT SOURCE
LOTSLOPE%
VESTED DATE
Building Permit
PLAN CHECK NO:
Plumbing
0
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED: THIS PERMIT COVERS WORK TO
Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
Grading
E DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
I
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00,005(A)(5)
uI
L PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
OCCUPANT
GROUP
OCCUPANT
LOAD
II-ft-
Description
State Surcharge
City Surcharge
Base Fee
I
FEE
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
Fire Review,
Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
E EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
47Z�421
r
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Landscapelnsp.
Total Amt. Due,
r FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
3 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
J E ANY ORDINANCE PROVISION.'
0 NOR LIMIT IN ANY WAY THE CITY'S A131LITY TO ENFORC
Recording Fee
Receipt#
APPLICATION APORbVAL
I HEREBY ACKNOWL DGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
This application I% not a pui nit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
CALL
Building Official or hisihor Deputy. and Fees are paid, and
TION: AND
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt is ackncKledged in space provided
WORKMEN'S COMPE44ATION INSURANCE AND RCW 18:27.
FIC SIGNATURE
DATE
0 __L_ - -
SIGNATU AG DATE (425)
!IGNE Z 10
T)
C- D E
L: 771-0220
ATTENTION % EXT. 1333
41
STRUCTURE UNTIL ea�Y
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL FILE YFl I OW INSPAOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 if IBC110 I IRC110. A ee /9 11�*, PINK - OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU A'__E MAKING 4 COPIES
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