20000651.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
DOMAIN (CURDS, SIDEWALKS. DRIVEWAYS, MAROUEES. ETC.1 WILL RECURS
STXVE SURCHARGE
:I SEPARATE PERMISSION
PERMIT APPLICATi N: 180 AYS
PERMIT LIMIT. 1 AR � PROVIDE. WORK IS STARTED WITHIN ISODAYS
YE
END REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-AP'LICANTT ON. BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
ULIMITIN
W� IN IN . A R E DE.NIll DEFEND AND HOLD HARMLESS THE CITY OF
TERES S TO,
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A ES PATE1. NATURE. ARISING On C
THIS ERMIT. ISSUANCE OF THIS PERMIT SHALL 'OT BE
PLAN CHECK DEPOSIT
FROM THE ISSUANCE OF
T 0 OR REDUCE ANY REQUIREMENT OF ANY CITY CIRDININCE
DEEMED =MODIIY�'WTAIVE
'W NCE PROViSION
ANYWAY THE CITY'SABIIITY TO ENFORCE ANYORDINA
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N OR
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THATI HAVE READ THIS APPLICATION, THAT THE INFORMATION
OR TH DULY AUTHORIZED AGENT OF
GIVEN 15 CORRECT, AND THAT I AM THE OWNER,
WITHIRCITY AND STATE LAWS REGULATING CONSTRUC
CALL
THEOINER I AGREE TO COMPLY
L BE EMPLOYED
TK)N. AND IN .IN. THE WORK AUTH Z ED THEREBY. NO PERSON WIL RE LATING TO
FOR INSPECTI,
M VIOLATION OF THE LABOR CODE OF THE STATE,OF WASHINGTON
WORKMEN S COMPENS SURANCE AND RCW I . 2,
DATE�JGNED
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771-0220
EXT 333
ATTENTION
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-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
VALUATION
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WEVELO TAENT SERVICES CTR.
CITY OFEDMONDS
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APPROVED BY PLANNING
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RIGHT-OF-WAY CONSTRUCTION PERMIT
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RECEIVED
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ENGINEERING APPROVAL AS NOTED
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Underground Wiring Required
Hydraulics Permit
plat/Subdivision Requirements
street Dedications
Easements - Public/Private
Engineering Storm Drain Review Feel
Engineering 2.2 Inspection Fee
Drainage Plan (On -site)
Setback - Storm Drain Line
open Ditch - Existing
Culvert Required
Culvert Size
Shoulder Drainage/Shale Op- Runoff
Catch Basin Required
Driveway Slope & Vehicle Access
Sidewalk Required
curb & Gutter Required
curb Cut for Driveway Required
street Paving Required
Right -of -Way Construction Permit Required
Bond Required for Public Improvements
FEMA Map Check/Water Table
Vcc� 9,0.0a . egs,
Side Sewer Availability
Calculate Sewer Fee if No LID#
Water Meter Size
le WAI— A-�?—I; 11;10
water Meter Charge Required
Hydrant Required
Street Cut
Miscellaneous
RW Permit #
Date Issued
Receipt #
SS Permit # Date Issued ),o- Receipt# Lg_SD__�
Meter Size ?2(q Paid$ 8(00," Date _L? Receipt # I k -7 1
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P ERmIT APPLICAtioN: ISD DAYS
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ENG. REVIEW FEES
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SEE BACKOF PINK PEA41T FOR MOREINFORYAVD�
ON BEHAL F HIS OR HER S�OUBE. HEIRS, ASSIGNS AND SUC ESORs
;APPLICANT
N INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPINGE1
2 EoMoNOS�WASHiNGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FRO. ANYAND
Y
DIRE Y
ALLCLAIMS FOR DAMAGES OF WHATEVER NATURE.ARISING CT F
INSPECTION F
RFc IP
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FROM THE ISSUANCE OF THIS PERIAIT ISSUANCE OF THIS PERMIT SHALL NOT BE
EPOSIT
PLAN CHECK DEPOSIT
-
DEEME D TO MODIFY. WAIVE OR REDUCE ANY REQUI REMENT OF AN Y CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITY'S ABILI TY TO ENFORCE ANY ORDINANCE PROVI SION�
1-4
K EIPT
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT 01
P ..... I �Md .., b, thde.
THEOWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGUI_ATINr CONSTRUC.
BE EMPLOYED
CALL
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TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL
RELATING TO
FOR INSPECTION ,l 11 1—.111d9ld � -PaPO P-1dod
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON
WORKMEN'S COMPENS�J;2gl I INSURANCE AND POW 18.27.
o��I�IALS �IGNATUD
S 1 N E R 0 44�G�5 N D E SIGNED
(425)
U_Y
7 �(�W �T)
(P-J-M
771-0220
1
FELEA
ATTENTION
EXT 333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
L
INSPECTION HAS BEEN MADE AND APPROVA�
ORIGINAL -FILE YELLOW INSPECTOR
A FINAL
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SEW [ON,
FAX
PINK -OWNER GOLD ASSESSOR
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