20051060.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEiNAME OF BUSINESS
MAILING ADDRESMS
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CITY ZIP TELEPHONE
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DATE
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CITY ZIP TELEPHONE
EXPIRATION DATE Cif KED BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
STATE LXENSE NUMBER I REQ 'D COMPLETED I EXEJ.APT
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CA# 4?!j5 ZONE SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO.
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WAIVER 0 ALLOWED I PROPOSED ALLOWED I PROPOSED
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LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
a -PLUMBING MECH ROPOSED REAR FRONT UR SIDE REAR
[Re'NEW [?"RESIDENTIAL ALLOWED P FRONT SIDE
[] COMMERCIAL COMPLIANCE OR 32
ADDITION CHANGE OF USE 2
E] MIXED USE a
PARKING LOTARE PLANNING REVIEWED BY DATE
OV L-15 .9
REMODEL MULTIFAMILY SIGN REQ'D PRC IDED
FENCE
REPAIR cyDs ( x FT.) REMARKS
DEMOLISH TANK o OTHER
" ARAGE RETAINING WALL FIRE SPRINKLER
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'CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN�
NUMBER NUMBER OF
DWELLING
OF UNITS
STORIES
DESCRIBE WORK TO BE DONE
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PLAN CHECK NO:
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SPECIAL INSPECTIO
REQUIRED 1:1 YES
REMARKS
GEOTECH REPORT
BY:
STRUCTMA
BY:
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OCCUPANT
GROUP
CONSULTANT OCCUPANT
LOAD
Description I FEE
Plan Check
VESTED DATE <
Building Permit -70 t,
Plumbing Z
Mechanical
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Grading
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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUJ31C
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
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SEPARATE PERMISSION.
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 SUCCESSORS
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 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.,
Fire Review
Fire Inspection
Landscapeinsp.
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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO.
WORKMEN'S C��SATION ISURANCE AND RCW 18:27.
CALL
FOR INSPECTION
(425)
771-0220
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DATE SIGNED
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PERMIT EXPIRES
PERMIT I
10
NUMBER
JOB
ADDRESS Y)
SUITE/APT#
PLAT NAMEISU BDIVI SION NO.
LOT NO.
LID NO
LID FEk
PUBLIC'RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPAppioved
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RW Permit Required
Street use Permit Required
EXISTING PROPOSED
inspection Required
Sidewalk Required
REQUIRED DEDICATION ____
FT
unauftireund
Wiring roquired
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED'
YES 13 NO13
LAU
REMARKd
OWN ERIC ONTRACTOR RESPONSIBLE
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FOR EROSION CONTROLIDRAINAGE E5
ENGINEERING REVIEWED BY
FIRE REVIEWED BY
Description FEE
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State Surcharge
City Surcharge
Base Fee k4<1? 4�)
rPlan Chk. Deposit
Receipt #
Tot I
a Amt. Due
Receipt#
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official of his/her Deputy and Fous are paid, and
receipt isacknowledged in space providod ,
FICINI.S SIGNATUO. DATE
RUL
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ATTEWTION 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-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 I IBC110 if IRC110.
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Height CalculAtion Worksheet
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Average Grade
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Max Height (2,5.'1 (0
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Actual Height (A+B71 -C) 54-
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FINAL PROJECTAPPRIDWAL FORM
PERMIT 11,EQ( DATE INSPECTED
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DESCRIPTION OF WORK TOBEINSPECTED rn I"W)"
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A. field inspection was conducted to determine compliance with a
approved pl iis.'.- tinal app�oval'
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.�; that there are.. no - objections 'from the above signed Department to thc,., releas e -of,.
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..denotes
PERFORMANCEBONDS and the granting o
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GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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0 Copyof CONDITION$- g*iven to,owner/contra6tor by, ins'pector
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FAILED FINAL INSPECTION -.,OUTSTANDING ISSUES
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0 Copy of CORRECTION NOTICE' given to owner/contractor byinpectoir
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
:Date Signature
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