BLD20050240.PDFDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
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PERMIT
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ADDRESS J A T h r ilnl % , JUITE/APTI
PLAT NAME/SUBDIVISION NO. I LOT.
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CITY
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NAME METER SIZE I LINE SIZE I NO. OF FIXTURES
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LID NO.
LID FEE $
TESCP Approved
RW Permit Required
Street Use Permit Required
Inspection Required
Sidewalk Required
Underground
Wiring required
PRV REQUIRED
YES 13 NO 13
t= ADDRESS REMARKS
= OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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ENGINEERING REVIEWED
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TELEPHONE
STATE LICENSE NUMBER
EXPIRATION DATE
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INSPECTION
REQ'D
SEPA
COMPLETED EXEMPT
0 YES 13 NO
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SIGN AREA
ALLOWED •.,PROPOSED.
HEIGHT
ALLOWED PROPOSED
PROPERTY TAX ACCOUNT PARCEL NO:
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❑ CHANGE OF USE
❑ SIGN -' '
LOT COVERAGE' , ,
ALLOWED, PROPOSED
REQUIRED SETBACKS (FT.)
'FRONT SIDE`
PROPOSED SETBACKS (FT.)
FRONT-' UR SIDE REAR
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REQ'D PROVIDED
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❑ DEMOLISH
❑" TANK
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❑
❑GARAGE
CARPORT
RETAINING WALL FIRE SPRINKLER "
❑, ROCKERY ❑ FIRE ALARM
(TYPE OF USE,
NESS ORACTIVI Y) EXPLAIN:
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TVP TRUCTI N
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OCCUPANT
GROUP:
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NUMBER
OF
STORIES
NUMBER OF
DWELLING
UNITS
S14ECIAL INSPECTION
REQUIRED 13, ES
CONSULTANT
OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE
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STRUCTURAL DESIGN•
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VALUATION
Description FEE Description FEE
Plan Check ; I State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE
'Building Permit City Surcharge
PLAN CHECK NO:
I -Plumbing ' /7// Base Fee
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 HEREBY ACKNOWLEDGE THAT 1 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 THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S SENSATION INSURANCE AND RCW 18:27.
I SI N RE NE ORAGrC,—' , I DATE rO r I
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscape Insp.
Recordina Fee
CALL
FOR INSPECTION
(425)
771-0220
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION 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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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 IRC110.
10/04 PRESS HARD - YOU ARE MAKING 4 COPIES
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GOLD -ASSESSOR