20050236.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RE Permit Required aw Permit aequudd
Street Use Permit Required
EXISTING _PROPOSED! Inspection Required
Sidewalk Required
REQUIRED DEDICATION FT Underground
Woring requited
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
�� YES O NO4
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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�/I (.G ENGINEERING REVIEWED BY DATE
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4 It FIRE REVIEWED BY DATE W
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STATE LICENSE NUMBER E IRAN N D TE CHECKED Y VARIANCE OR CU SHORELINE OR ADB# INSPECTION SE
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a --T REQ'D COh1PLETED EXE6IPT
1 go FTC 1-- `%` l " !� F^ I � f I � YES ONO
CAN ZONE SIGN AREA HEIGHT
PROPER TAX ACCOUNT PARCEL NO.
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❑ NEW RESIDENTIAL PLUMBING 1 MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT. LIR SIDE REAR m
❑ COMMERCIAL COMPLIANCE OR
❑ ADDITION ❑ CHANGE OF USE z
❑ MIXED USE PARKING LOT AREA PLANNING REVIEWED BY DATE g
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REQ'D PROVIDED
❑
REPAIR ❑ GRADING
CYDS ❑ FENCE X FT.) REMARKS
❑ DEMOLISH ❑ TANK ❑ OTHER
GARAGE RETAINING
1:1CARPORT El ROCKERY WALL ElFIREALARM SPRINKLER
FIRE
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a(TYPE OF USE, BUSINES R ACTIVITY) EXPLAIN:
W.TYPE OF CO STRUCTION CODE OCCUPANT
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GROUP
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C OF DWELLING / SPECIAL INSPECTION CONSULTANT OCCUPANT
O STORIES UNITS LOAD
REQUIRED YES
DESCRIBE WORK TO BE DONE
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(� GEOTECH REPORT
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STRUCTURAL DESIGN
BY:
VALUATION
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a7 Description FEE Description FEE
Plan Check. State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE �--�-
Building Permit City Surcharge
PLAN CHECK NO: Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO MBChanICBI
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
t= SEPARATE PERMISSION.
i Engr. Review
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PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
a PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engf: Inspection
m 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
lu IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
:E EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
_ 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 Landscape Insp. Total Amt. Due
= NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF This application Is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• CALL Building Officiator his/her Deputy: and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED FOR INSPECTION receipt is acknowledged in space provided.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WOJKMEN'S COMPENSATION INSURANCE AND RCW 18:27, OFF I LS SIGN LfUf2E DAT
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SIGMA UR OWNER O qOE ): —! DATE SIGNED 0425)
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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- ORIGINAL -FILE YELLOW -INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1091 IBC110 I IRC110. PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD YOU ARE MAKING 4 COPIES -
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