20051049 (2).pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PR/O�RTY TAX C N A / VARIANCE OR Cu SHORELINE OR ADB# INSPECTION SEPA
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❑ NEW RESIDENTIAL ErPLUMBING / MECH D WAIVER ALLOWED PROPOSED ALLOWED PROPOSED
ADDITION ❑ COMMERCIAL COMPLIANCE OR D STUDY
❑ ❑ MIXED USE ❑ CHANGE OF USE LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
REMODEL ❑ MULTIFAMILY ❑ SIGN z
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❑ REPAIR ❑ GRADING CYDS ❑ ( X FT.) PARKING LOTAREA PLANNING REVIEWED BY DATE a
OTHER REO'D PROVIDED
❑ DEMOLISH ❑ TANK ❑
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CARPORT ❑ ROCKERY ❑ FIRE ALARM
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OF Z DWELLING OCCUPANT
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DESCRIBE WORK TO BE DONE / j/'/
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r Description FE7Descriptllon FEE _
HAAT, SO CE LOT SLOPE% VESTED DATE Plan Check urcharge
PLC/ADN�LlC1HECK N0: Building Permit City Surcharge
Plumbing n Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
Owl SEPARATE PERMISSION, Grading
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
W Engr. RBVIBW Recording Fee
PERMIT LIMIT: SEE ECDC 19.00,005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection Plan Chk. Deposit
y
*APPLICANT, ON BEHALF OF. HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF Fire Review Receipt #
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Q ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
= FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE Fire Inspection Total ARIL. Due t^---
oJ 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.0 Landscape Insp. Receipt # `
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 CALL This application is riot a permit until signed by the
THE OWNER. 1 AGREE TO COMPLY WI H CITY AND STATE LAWS REGULATING CONSTRUC• Building Official or hisiher Deputy and Fees are paid. and
TION; AND IN DOING T
ORK AU ORIZED THEREBY, NO PERSON WILL BE EMPLOYED FOR INSPECTION receipt is acknowledged in space provided
IN VIOLATION O E LA R C E OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S PENSATIO RANCE AND RCW 18:27. ( A 2C) OFFICIALS SIURE ATE
UR WNER OR ): DATE SIGNED `fLJr� Wte
C.
771 =0220
BELE SED BY DAT
EXT. 1333
ATTENVON
IT IS UNLAOiFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL.OR A CERTI- ORIGINAL • FILE • YELLOW • INSPECTOR
/ IBC110 / IRC110. PINK -OWNER •GOLD •ASSESSOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109
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