20000141.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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CITY ZIP
= I PERMIT EXPIRES
USE PERMIT
ZONE NUMBER
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ADDRESS f4
PLAT NAMEiSUBDIVISION NO. LOT NO, LID NO,
LID FEE S
1111311C FIGHT .1 WAY PER .1 lICIAL STREET MAP
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REQUIRED DEDICATION FT
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VALUATION
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CAT SOURCE GLAZING I LOT SLOPE % BUILDING
PLAN CHECK NO: IVEST111 DATE PLUMBING -vo
MECHANICAL Ll
THIS PERMIT AOTHO IZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC GRADINGIPILL
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS. MARQUEES, I.T.., WILL ED E
SEPARATE PERMISSION. 4MILE RICHARDS
PIRMITAPPLICATI N: 180 DAYS
PERMIT LIMIT. 1 YEAR . PROVIDED WORK 15 STARTED WITHIN 100 DAYS ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
A SIGNS ANDSUCCESORS ENO. INSPECTION FEE
;APPLICANT ON BEHALF OF HIS OR HER SPOUSE, HEIRS, S 0 'AND C PV
N INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY F
I EDMONDS. WASHINGTON, ITSOFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND INSFECIAI.N ;EE
4LLCLAIMSFORIAMAGE 0 WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
LANCE OF THIS P RMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
FR M THE ISSUANCE OF THIS P PLAN CHECK DEPOSIT
0 DEOEMSD TO MODIFY. WAIVE OR REDUCE ANY REGUIREIENT OF ANY ITYCROINAHCE
TY TO ENFORCE ANY ORDINANCE PROVISION.'
NOR LIMIT IN ANY WAYTHE CITY'S ABILI IR CIIII/VR211 I 1q,
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT; HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT AM THE OWNER, OR THE DULY AUTHORIZED AGENT Or
T EOWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL B.il Thil I. P-it Illil 11pod byII,.
H ig Off,J 11 N111,11 Dlplty: -d F111 11, P d. 1�d
TICN� AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED d
I RELATING TO INSPECTION gw!. .,pp,dld.
N V1 LATION OF THE LABOR CODE OF THE STATE OF WASHINGTON FOR _d I
WORKMEN'S COMPENSATION INSURANCE ANDRCW IB.27. URE T
SIGNATURE (OWNER OR� T DATE S NE (425)
0
0 1� C'�J_ 11-111�11 RELEASED BY DATE
ATTEUTION EXT 333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE YELLOW- INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK - OWNER GOLD - ASSESSOR
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SPECIAL INSPECTION 0
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FINAL APPROVAL FOR
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ATE RECEIVED
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us P ERMT
CITY OF EDMONDS
ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION
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OWNOF��ME F BUSINESS
FLAT NAMEISUBDIVISION NO.
LOT NO,
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LID F�E S
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
P.
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METER SIZE LINE SIZE NU_0F FIXTURES
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NAME
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ADDRESS
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FIRE REVIEWED BY DATE
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IFIATIO DATE CHECKEDBY
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REMARKS
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK To
He 0 NE ON PRIVATE PROPERTY ONLY. ANY CONSTR UCTION ON THE PUBLIC
GRADINGIFILL
DOMAIN (CURBS, SIDEWALKS RIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SE�AD PERMJS!�ION.
_FATE
4we S RCHARGE
LAD
PER. TAPPLICATION: 1800 AYS
. ... __.
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PERMIT LIMIT. 1 YEAR ' PFIOVIDED WORK IS STARTED WITHIN 180 DAYS
1 ENG REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORM ION
FHI ORHERSPOUS HSIRS.A.1111,NSANDSUGCES RS
_T
'APPLICANT, ON BEHALF OINOEMNIlY.
ENG. INSPECTION FEE
N E E DAN D HA E BE TH E CITY OF
0 INDEM 'FY. 0 F N 0 HOL RML
w IN " - FEE ACRE S DEFENCE
LANDSCAPING
US ITS OFFICIALS . EM " E AN D AD ENT S F ANYA,,D
EC..N WASHIN.T."S -YE Ei'N
INSPECTION FEE
G G OF WHATEVER NATURE. AR' C, R.CTLY ORIN.I"ECTLY
ALLCLA '.S OR I
NOT BE
ISEU AMA E
T ANCE OF T I SHALL
HE H E PERMIT ISSUANCE OF THIS PER. CE
ANY CITY OF��NAN
PLAN CHECK DEPOSIT
C EANY E-UF�MENT OF
ECT. MODIFY - WAIVE OR RED" R
RIC YOF.IN N. , VISION.
EAN A E R
'T'N NY W Y T CIY.B DILI Ty To N .
N.RL A A HE A E F
I HAVE READ THIS APPLICATION IN,, "I",
APPLICATION
A
I HEREBY ACKNOWLEDGE THAT
_�
AND THAT I AM THE OWNER. OR THE DLl_,AUTH.RIZl. AGENT OF
T1,1. -� 1-1 � P-11 "I'll -1-
GIVEN IS CORRECT:
Ly WITH CITY AND STATE LAWS EGULATING CONSTRUC
CALL B,,,9 .111-t .1 N11h., D.I,ul, ��d F .1. P-,
"0 6 D�NG TNE�WOFX AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOY ED
RELATI NO To
FOR, INSPECTION
d . p'-d.d
OF TH L AT
E ABOR
,� VI101A ION CODE OF THE ST W E OF WASHINGTON
'
IB.27.
A I -
LIFE T
N SURANCE AND FIG
,..,ME E COMPENSATION IN
SIGNATURE (OWNER ORREN 1) ATE
(425)
OFFICIAL
0,-3 1
Q-
:771-0220
FIE Y DA E
EASED
1 333
N
IT IS UNLAWFUL TO USE 08 OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
INSPECTOR
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
OR16INAL - FILE YELLOW -
PINK -OWNER GOLD -ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
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