20056723.pdfI
DATE RECEIVE�,-
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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CITY ZIP TELEPHONE
NAME
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PERMIT EXPIRES
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PERMIT
NUMBER
JOB
ADDRESS
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PLAT NAMEISUBDIVISION NO.
LOT NO
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LID NO
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPApproved
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13
RW Permit Required
0
EXISTING PROPOSED
Street Use Permit Requited
Inspection Required
E3
Sidewalk Required
REQUIRED DEDICATION
FT
Underground
Wiring required
METER SIZE
LINE SIZE
OF FIXTURES
PRV REQUIRED
TNO.
YESO NO CI
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REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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CITY ZIP TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE I&HECKED BY
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PROPERTY TAX ACCOUNT PARCEL NO
NEW
RESIDENTIAL
ADDITION
COMMERCIAL
MIXED USE
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
:GARAGE
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RETAINING WALL
El
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY � EXPLAIN;
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NUMBER
NUMBER OF
OF
DWELLING
STORIES
UNITS
DESCRIBE WORK TO BE DONE
LOTSLOPE%
PLAN CHECK NO:
PLUMBING it MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( x FT.)
OT7HER
FIRE SPRINKLER
FIRE ALARM
VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
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
'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.'
I I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
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G GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
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THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
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TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
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kINVIOLA ION OF THE LA R C 0 THE STATE OF WASHINGTON RELATING TO
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IF
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WORKMEN'S COMPENSATION CE AND RCW 18:27.
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SIGNATURE (OWNER AGEN�Ty
DATIESIGNED
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ENGINEERING REVIEWED BY
FIRE REVIEWED BY
VARIANCE OR CU
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WAIVER 13
STUDY [3
LOT COVERAGE
ALLOWED PROPOSED
PARKING
REO'D , PROVIDED
REMARKS
SPEJIAL INSPECTION
REQUIRED UYES
REMARKS
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
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VALUATION
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Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recordina Fee
DATE
SHORELINE ORADIII I INSPECTION SEPA
REO'D I COMPLETID I EXEMPT
13YES ONO
ZONE SIGN AREA HEIGHT
I ALLOWED , PROPOSED I ALLOWED . PROPOSED
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REQUIRED SET13ACKS (FT.) PROPOSED SETBACKS (FT.)
FRONT SIDE REAR FRONT LJR SIDE REAR
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LOT AREA I PLANNING REVIEWED BY DATE
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CALL
FOR INSPECTION
(425)
771-0220
ATTENTION 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 If IBC110 / IRC1110.
OCCUPANT
LOAD
FEE Description
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
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FEE
!AReceipt #
To
Total Amt. Due S5
Receipt #
APP I ION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy! and Fees are paid, and
receipt is acknowledged in space provided
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ORIGINAL -FILE YELLOW -INSPECTOR
PINK -OWNER GOLD - ASSESSOR
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FiNAL PROJECT APPROVAL FORM
TO:
DATE: —
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASE SIGN
ENGINEERING DIVISION DATE
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PLrASr SIGN
PLANNING DIVISION DATE
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PLEASESIGN
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PERMIT # ADB#
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DESCRIPTION OF WORK TO BE INSPECTED
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A field inspection was conducted to determine compliance with -approved plans. Final approval
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denotes that there are no objections from the above signed Department to. the release of
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PERFORMANCE BONDS and the granting of:
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GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS, NOTED
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0 C opy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES..
0 Copy of CORRECTION NOTICE given to owner/contracto.r by inpector