20000138 (2).pdfRECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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PLAT NAME/SUBDIVISION NO. LOT NO. LID NO j
LID FEES
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Pe mit equived ❑
RLY Permit Required Q
_I . Street Use Permit Req'd ❑
Inspection Required ❑
EXISTING PROPOSED Sioewalle Required ❑
REQUIRED DEDICATION Winn
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Wiring required ❑.
METER SIZE LINE SIZE NO, OF FIXTURES PRV REQUIRED
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REMARKS Z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL /DRAINAGE z
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A E OR CUHOR INE j,)R AD q INSPECTION BOND
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SEPA REVIEW SIGN AREA HEIGHT
PLETLOWED PROP 'ED ALLOWED PROPOSED
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OT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) .
,LL OWED PROPOSED FRONT SIDE REAR FRONT LIR SI E REAR t7
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PARKING LOT AREA P NN h REVIEWED BY DATE a
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S� EMARKS
PROGRESS INSPECTIONS PER UBC 108/1FINAL INSPECTION REQ'D
I VALUATION I FEE
PLAN CHECK FEE
yEAT O RCE GLAZING % LOT SLOPE °/
�- BUILDING
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PLAN CHECK NO: � VESTED DATE PLUMBING
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MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
RE DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC,) WILL REQUIRE GRADING/FILL
F SEPARATE PERMISSION.
STATE SURCHARGE ^
PERMIT APPLICATION: 180 DAYS
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a PERMIT LIMIT: 1 YEAR _ PROVIDED WORK IS STARTED WITHIN 180 DAYS ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
N "APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS ENG. INSPECTION FEE
Lu IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF LANDSCAPING
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2 EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND INSPECTION FEE
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a ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLYOR INDIRECTLY
RECEIPT I
= FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT
of DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE V
O NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION." RECEIPT
_ TOTAL AMOUNT DUE.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT I AM T HE OWNER. OR THE DULY AUTHORIZED AGENT OF
THE OWNER I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• CALL This application is not a permit until signed by the
TION, AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Foos aro paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION recelpt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18 27 OFFICIAL SIGN TURE DATE
SIGNATOR: (OWNER DATE SIGNED (425)
I ! / 1 '0220 RELEASED BY DAT =
ATTENTION EXT 333' �y
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 7710221 )
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- I ORIGINAL • FILE YELLOW • INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK • OWNER GOLD • ASSESSOR
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