20060520.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ER NAME/NAME OF BUSINESS
CITY
NAME
CITY
ZIP
TELEPHONE
TELEPHONE
CBL#
N
PERMIT EXPIRES C=
PERMIT
NUMBER
t' -
JOB UITE/APT#
ADDRESS 170�
PLAT NAME/SUBDIVISION NO. LOlNO. LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP 1LSCI2A;rproYea
HW Vomit RKaired
EXISTING Street use Perma Reganea
... __.. _ PROPOSED .............. .. _..-- _ .:._ ... Inspection Required
Siaora,n Required
REQUIRED DEDICATION FT _ Unaergroura
Wsong rC ulea
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES ❑ NO ❑
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
REVIEWED BY DATE
LEPHONE PUBLIC WORKS RE
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PIRATION D TE CH KED BY FIRE REVIEWED BY
DATE
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W
W
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VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA "I
PROPERTY TAX ACCOUNT PARCEL NO. / REO'D COMPLETED EXEMPT 0/ - 0 YES 0 NO M
A
w CA# ZONE SIGN AREA HEIGHT
❑ NEW y❑ RESIDENTIAL 1XI PLUMBING / MECH ❑ WAIVER ALLOWED PROPOSED ALLOWED PROPOSED T
IM COMMERCIAL COMPLIANCE OR
[3 STUDY _
❑ ADDITION 111fff❑��� MIXED USE ❑ CHANGE OF USE LOT COVERAGE REQUIRED SETBACKS (FT)[FRONT
PROPOSED SETBACKS (FT.) 0
ALLOWED PROPOSED FRONT SIDE REAR UR SIDE REAR � m
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN z m
z O
❑ REPAIR ❑ GRADING CYDS ❑ FENCE a O C
( X FT.) PARKING LOTAREA PLANNING REVIEWED BY DATE j
REO'D PROVIDED
❑ DEMOLISH ❑ TANK LJ r-1 OTHER I = m
m Z
GARAGE RETAINING ❑ CARPORT ❑ ROCKERY. WALL ❑ FIREALARM FIRE LER REMARKS Q
DZ
i (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: .
ri2
u NUMBER NUMBER OF
a OF DWELLING . / TYPE OFr�1�F�1! ION CODE GROUP cl "OWn
ri
D STORIES UNITS ��/VVV ✓
DESCRIBE WORK TO BE DONE -�
SPECIAL INSPECTION CONSULTANT OCCUPANT _
REQUIRED YES LOAD M Iii
o N
16
REMARKS z 0 ri
C (n
GEOTECH REPORT K Cn
BY: m i M r
STRUCTURAL DESIGN m
BY. b
VALUATION X
Lo chTnb W
Description FEE Description FEE Z
HEAT SOURCE LOT SLOPE% VESTED DATE Pian Check State Surcharge
PLAN CHECK NO: Building Permit . City Surcharge Z i
Plumbing Base Fee O
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO Mechanical n
ecanca
t BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC M
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
t SEPARATE PERMISSION. Grading
i
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
M
Engr. Review Recording Fee
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection Plan Chk. Deposit
u1 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
Lu
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF Fire Review Receipt #
M EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
R ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY r.
= FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Fire Inspection Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
= NOR LIMIT IN ANY WAV THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'Landscape Insp. Receipt q
1 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 perrnit until signed by the
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• Building Official or his/her Deputy, and Fees are paid. and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED FOR INSPECTION
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO receipt Is acknowledged tit space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 10:27. �� A L n5 2SIG E DATE
SIG T RE (OWNE OR AGENT): DATE SIGNED Y'01A III)
10G0
DATE
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 / IBC110 I IRC11 O. ORIGINAL •FILE YELLOW ,INSPECTOR
PINK -OWNER •GOLD •ASSESSOR
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