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PERMIT EXPIRES APL
CITY OF EDMONDS NUMBER J�4!
CONSTRUCTION PERMIT APPLICATION ooREss %f SUITE/APTn
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CITY ZIP TELEPHONE EXISTING PROPOSED inspocuonRaq„rny ❑
901vDi .s 7 002 0 �fv-S % 6 sQi .,pa �� ..._. _ Saewa Required ❑
REQUIRED DE C ON. FT �. umfe war.-... ❑
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AUDRE Aj � RECYCLE REVIEWED BY DATE
CITY ZIP TELEPHONE 0 PUBLIC WORKS REVIEWED BY DATE
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j T�attio E LICENSE NUMB �R EXP IRA I;' E C FIRE REVIEWED BY DATE w¢ ± 0
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a PROPERTY TAX ACCOUNT PARCEL NO.
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J ❑ NEWlCloopolItTI!1SIDENTIAL UMBING/ CH
COMMERCIAL ` COMPLIANCE
ADDITION ❑ CHANGE OF USE
❑ MIXED USE
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN
❑❑ GRADING ❑ FENCE X
REPAIR CYDS
❑ DEMOLISH ❑ TANK ❑ OTHER
z ❑GARAGE RETAINING FIRE
CARPORT ❑ ROCKERY WALL 1:1FIREALARMKLER
OF (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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DESCRIBE WORK TO BE DONE
REQ'D COMPLETED EXE//PT
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CAA ZONE SIGN AREA HEIGHT
❑ WAIVER ALLOWED PROPOSED ALLOWED PROPOSED OM
❑ STUDY I C
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) I m 0
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR '—I n
FT.) PARK114G LOTAREA PLANNING REVIEWED BY DATE a I m Z
REO'D I PROVIDED p
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Description FEE Description FEE40 lit Aas akiP115,1� 0)
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HEAT SOURCE Ur SL 012% Ll VESTED DATE Plan Check State Surcharge Z
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PLAN CHECK NO: n
Plumbing Base Fee m
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO Mechanical
ig BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC , 30
EDOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC,) WILL REQUIRE
h SEPARATE PERMISSION. Grading
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= PERMIT APPLICATION: SEE ECDC 19,00,005(A)(5)
i PERMIT LIMIT: SEE ECDC 19,00.005(A)(6) Engf. Review Recording Fee
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection Plan Chk. Deposit
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. •APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
.jIN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF Fire Review Receipt
M EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY Fire Inspection . EETotal Amt. Due
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
_ NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. • Landscape lnsp. Receipt A
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 CALL This appheahnn is not a Pormn unci signori ny the
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• Bwid ng Othr.,al or his nor Doputy and Foos are pawl and
PION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED FOR INSPECTION roco ltt,s ac..Mnowlodgod in space provided
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S SATION INSURANCE AND RCW 18,27. / w r�C� UPMC qL" SiCiNATURL D TL
SIG iURE WNE A DATE GNEO 1516
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDIIJG OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- OHIGINAL :ILL YLLLOW INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109 I IBC110 If IRC110. • OINK . uWNLH • GOLD • ASSESSOR
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