20051145.pdfDATE PIECE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
CITY ZIP TELEPHONE
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NAME
ADDRESS
ZIP
NAME
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PERMIT EXPIRES
PERMIT
NUMBER
JOB SUITE/APT#
ADDRESS
NAMEISUBDIVISION NO
T NO.
7
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TLSCP Appw�ecl
RW Porm.1 Reqa,fpd
Street Use Polm.] Reqjael
EXISTING PROPOSED
inspection Requiled
SirteAalK Requ,red
REQUIRED DEDICATION FT
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METER SIZE SIZE
NO. OF FIXTURES
PRV REQUIRED
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REMARKS J Ay C D 01- Vent Con ors reauired
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R REOYCLE RE 11
EICYCLE REVIEWED
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DATE
DATE
DATE
VARIANCE OR CU SHORELINE OR ADB# INSPEC�ION I SEPA
PROPERTY TAX ACCOUNT PARCEL NO. REO D COMPLETED EXEMPT
7
NEW
12FRESIDENTIAL
PLUMBING / MECH
ADDITION
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COMMERCIAL
COMPLIANCE OR
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MIXED USE
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
CYDS
FENCE
X
DEMOLISH
TANK
OTHER
GARAGE
CARPORT
RETAINING WALL
FIRE SPRINKLER
ROCKERY
FIREALARM
(TYPE OF USE, BUSINESS OR ACTIVIT&XPLAI - N.-
NUMBER
NUMBER OF
OF
STORIES
DWELLING
UNITS
DESCRIBE WORK TO BE DONE
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ALLOWED PROPOSED
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ALLOWED PROPOSED
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LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT URSIDE REAR
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I REO'D I PROVIDED
REMARKS
TYPE 0 1 WOSTRJI
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SPECIAL INSPECTION
REQUIRED 13YES
REMARKS
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BY,
CONSULTANT
PANT
Description
FEE
Descripilon
FEE
Plan Check
State Surcharge
HEAT SOURCE
LOT SIOPE77
VESTED DATE
6.4--r
Building Permit
City Surcharge
PLAN CHECK NO:
Plumbing
Base Fee
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
.j
SEPARATE PERMISSION.
Grading
W PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
Engr. Review
Recording Fee
IL PERMIT LIMIT* SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
Plan Chk. Deposit
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
Uj
.j 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
M
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Fire Inspection
Total 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
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Landscapelnsp.
Receipt #
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 application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULAT114G CONSTRUC-
FOR INSPECTION
Building Official or his/her Deputy: and Fees are paid. and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
receipt ls,15kf�cwledged i space provided
IN VIOLATION OF THE LA30 CODE OF THE STATE OF WASHINGTON RELATING TO
INSURANCE
WORKMEN'S COMPENSATION AND RCW 18:27.
(425)
'ATE ,
0 ICIAr)IGN Tt)
SIGNATURE (OWNER i! R AGENT),: DATE SIGNED
771.0220
0�
RELEASED113Y
EX T. 1333
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
ORIGINAL - FILE - YELLOW INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC11 0 / IRC11 0.
PINK -'OWNER - GOLD - ASSESSOR
6/05 PRESS HARD - YOU ARE MAKING 4 COPIES
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