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CITY OF EDMONDS
NUMBER
CONSTRUCTION PERMIT APPLICATION
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ER NAMENAME OF BUSINESS
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EXP I
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PROPOSED FRONT SID REAR FRONT UPSIDE REAR
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C MPLIANCE OR
0 ADDITION CHANGE OF USE
PARKING LOT A
0 REMODEL SIGN
REUG I PROVIDED
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0 REPAIR C] GRADING CYDS X FT)
EMARKS
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r (TYPE OF USE. B SINESS 0 ITY) EXPLAIN
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SPECIAL INSPECTOR ]AREA
o STORIES
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REQUIRED
cl YES
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REQ'EI
VALUATION
FEE
PLAN CHECK FEE
HEAT SOURCE G�IING, LOT SLOPE I
BUILDING
PLAN CHECK NO: JVIITEDDITE
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZE ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATESPROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MAROUEES. ETC.) WILL REQUIRE
:I SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT APPLICATION: lob DAYS
PERMIT LIMIt IYEAR ' PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
on ON BEHALF PHI OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
;APPLICANT.
or :NDEMN DEFEND AND HOLD HARMLESS THE CITY .1
W NTEREST. AGREES TO PY M N
FRO A YANG
LANDSCAPING
EDMONDS, WASHINGT N T OF AL EMPLOYEES, AND AGENTS
0 S' IN IRECTLY
NATURE. ARISING DIRECTLY OR D
INSPECTION FEE
ECEIPT
RECEIPT
M
A OF VER
w LLcmmsFORDA AGE� WHFATICEI SHALL NOT BE
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT
PLAN CHECK DEPOSIT
DEE MED TO MODIFY. WAIVE OR REDUCE ANY REQUIREME NT OF ANY CITY ORDINANCE
0 NOR Ll MIT IN ANY WAY THE CITY'$ ABI LITY TO ENFORCE ANY ORDINANCE PROVISION.-
RECEIPT
TOTAL AMOUNT OUR
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE IN FORMATION
APPLICATION APPROVAL
GIVEN I CORRECT. AND THAT I AM THE OWNER. OR THE LILLY AUTHORIZLO AGENT OF
Ti,ls PPll--tI-n is P.,rK until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
ED
CALL BllIdilQ 011i.IaL or hl=r Depu no Fees — p.sl. no
TION; AND IN Do NG THE WORK AUTHOR!Z ED TH ERSBY. NOMPE�R�SON WILL BE EMPLOY
NGTON RELATING TO
FOR INSPECTION -;PI is --k lodged in op,,o Pidad.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF
WORKMEN��NPENSATION INSURgE AND RCW 11,11
CFrIC A S SIGNATURE DATE
(OWNER OR ATE SIGNE
(425) cl
f /,�) �l �b
771-0220 DATE
E ASEDBY
-kffkNTION
EXT 333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL FILE - YELLOW. INSPECTOR
D - ASSESSOR
A
HAS BEEN GRANTED. UBC SECTION 109
FAX PINK - OWNS R . GOL
cATE OF OCCUPANCY
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