20000308.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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E-MITAPPLIC-1 11: 1100-S
PEpMll..111YEA. - P"OV'D ED WORK IS STARTED WITHIN 180 DAYS
ENG, REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
APPLICANT, ON BEHALF OF HIS OR HER SPOUSE� HEIRS, ASSIGNS A SUCCESO S
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PROVISION,'
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TOTAL AMOUNT 0
�HEREDY ACKNOWLEDGE THAT$ HAVE READ THIS APPLICATION, THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN I RAECT, AND T AT I AM THE OWNER, OR THE DULY AUTHORIZE. AGENT OF
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IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON
D E
WORKMENS C H � INSURANCE AND RCW 18.21
OFFICIALS S111
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771-0221
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INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI�
ORIGINAL - FILE - YELLOW INSPECTOR
A FINAL
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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REQUIRED DEDICATION— FT
YES 13 NO
—REQUIRED
REMARKS
—PRI-NTRACTOR RESPONSIBLE FOR EROSION CONTSOUORAINAGE
FIRE REVIEWED By DATE
VARIANCE 08 CU
SHORELINE OR AOB#
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REDO
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ECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC,
GRADINGIFILL
M
I:
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEE% ETC.) WILL REQUIR
SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT APPLICATION: 18o DAYS
P I
PERMIT LIMIT I YEAR ROViDED WORK S STARTED WITHIN HID DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENG. INSPECTION FEE
APPUCANT� ON SEI ALF 0 HIS OR 111. SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
HE CITY 01
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T AGREES TO INDEMNIFYIDEENG AND HOLD T
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DIRECTLYOR INDIRECTLY
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A OF THIS PERMIT SHALL NOT BE
CHECK DEPOSIT
OF THIS PERMIT. ISSUANCE
OF ANY Cil Y ORDINANCE
PLAN
ORDINANCE PROVISION.-
TOTAL AMOUNT DUE
HAVE REA. THIS APPLICATION; THAT THE INFORMATION
OF
,,,_..y
"YEN " CUPPED AT AM THE OWNER, OR THE DULY AUTHORIZED AGENT
'T A PLY WITH CITY AND STATE LAWS REGULATING CONSTPUC,
CALL
T E OWN ,
THE ING K AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
TION; AND IN 0 ING
OF THE LA 0 CODE OF THE STATE OF WASHINGTON RELATING TO
FO R INSPECTION
IN VIOLATION
WORKMEN'S C P TI NINSURA NC5 AND PCW 18,27.
.
Ep N
(425)
771-0220
EXT 333
ION
IT IS UNLAWFUL TO USE 08 OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
A
HAS BEEN GRANTED. USC SECTION 109
FAX
CATE OF OCCUPANCY
5.13
----------
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VALUATION I FEE
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