20051162.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
O%�.V�AME/NAME OF SU S
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PERMIT EXPIRES 1 IN,
PERMIT
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ADDRESS
PLAT NAME.,SUBDIVISION NO LOT NO. LID NO
LID FEE S
PUBUC RIGHT OF WAY PER OFFICIAL STREET MAP I L SC V At, pro� e a
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METER SIZE LINE SIZE. NO. OF FIXTURES PRV REQUIRED
I GAR PIJE TEST h'IUS' 6EE3 NO 11
REMARKS
OWNER�CONTRAC _AffiME&,gyRrgyQj9SP.E&,TDR,
AFFIDAVITS SHALL NU 1
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COMPLIANCE OR
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CHANGE OF USE
LOT COVERAGE
REQUIRED SETBACKS (FT)
PROPOSED SETBACKS (FT)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT L/RSIDE REAR
REMODEL
MULTIFAMILY
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REPAIR GRADING
CYDS
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PARKING
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FIRE SPRINKLER
REMARKS
CARPORT ROCKERY
FIRE ALARM
(TYPE 01 USE31NESS OELACTIVITY) EXPLAIN:
NUMBER
NU MBER OF
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TYPE 06NO�STFIUC�Th
OCCWP%NT�
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'FEE
Description
FEE
Description
Plan Check
State Surcharge
LOT SLOPE%
VESTED DATE
Building Permit
City Surcharge
MICE
PLAN CHECK NO:
Plumbing
Q0
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
Grading
SEPARATE PERMIS&ON.
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
Engr. Review
Recording Fee
116 PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
Engr. Inspection
Plan Chk. Depos it
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
OAPPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
W IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
Fire Review
Receipt #
i
2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Total Amt. Due
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
0 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
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Receipt #
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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 REGULATING CONSTRUC- Buoding official or h151her Deputy and Fees ate paid and
FOR INSPECTION
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
receipt is n.owie ecl in space pit vjdpd
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27. 0111, n116 IAIMR DATE
(425)
SIGNAPRE (OWNE� DATE SIGqLD 1 771-0220
W241110 RELEAS 'D Y DAT
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EXT. 1333
AYTtNTION 1// L�l
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL, V
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL - FILE - YELLOW - INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1 09 / IBC1 10 / IRC11 0. PINK -OWNER - GOLD - ASSESSOR
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