20051071.pdfDATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PLAT NAME/SUBDIVI SION NO.
LOT NO.
LID NO,
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required
Street Use Permit Required
EXISTING - PROPOSED
inspection Requited
Sidewalk Required
REQUIRED DEDICATION
FT
Unainground
Wiring required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YESO No E3
In addition to
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REQ'D 01 COIJPI IIED I EXEMPT
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CAN
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PARCEL NO.
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ALLOWED PROPOSED ALLOWED PROPOSED
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STUDY 13
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ELN�B I �N M E C H
LOT COVERAGE
PROPOSED
REQUIRED SETBACKS (FT V PROPOSED SETBACKS (FT.)
FRONT URSIDE REAR
ALLOWED
FRONT SID E REAR
COMMERCIAL
COMPLIANCE OR
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CHANGE OF USE
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LOTAREA PLANNING REVIEWED BY __DAIr
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GRADING
CYDS
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ROCKERY
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FIRE SPRINKLER
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REMARKS
OR ACTIVITY) EXPLAIN:
TYPE N
NUMBER OF
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on fuel -burning appliances passing
CODE
OF * `7 1 DWELLING SPECIAL INSPECTION CONSULTANT
STORIES UNITS
DESCRIBE WORK TO BE DONE
REQUIRED C
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REMARKS
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
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VALUATION
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Description
Plan Check
HEAT SOURCE LOT SLOPE% VESTED DATE
Building Permit
PLAN CHECK NO:
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Grading
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
Engr. Inspection
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
Fire Review
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
Fire Inspection
Landscapeinsp.
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.-
R ecording Fee
CALL
FOR INSPECTION
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 TWE LABOR CODE Or THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPEN AND RCW I 8:27.
'P��RANCE
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771-0220
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OCCUPANT
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ILOOCACDU PANT
FEE Description
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
,
1 Receipt # 1
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his1her Deputy: and Fees are paid, and
receipt is acknowledged in space provided
IA S IGN IRE DAT E
-EAStD Bi I DATE
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ATTtNTION X L I J .5,65
ITIS UNLAWFULTO USE ORd/CCUPYA BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC1110 / IRC110.
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
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