20000736.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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REMARKS
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�_T AUTHORIZES ONLY THE W RK NOTED, THIS PERMIT COVERS WORK TO
E . PRIVATE PROPERTY ONOLY, ANY CONSTRUCTION ON THE PUBLIC
GAADINGIFILL
DOMAIN SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
U HANGS
2 PERMIT APPLICATI N: 180 DAYS
PERMIT LIMIT.- I YEAR � PROVIDED WORK IS STARTED WITHIN 180 DAYS
5NG+ REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-US" HE A AND SUCCESORS
F HI IRS. SSIGNS
T S'
'Al P U'A NT�=T
ENG. INSPECTION FEE
IN,NTEHE. F DEFEND ANDHOLD HARMLESS THE Clly
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LANDSCAPING
EDMONDS, WASHINGTON. ITS OFFI 'EIALS. EMPLOYEIEL AND AGENTS FROM ANY AND
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BE
RECEIPT
FROM THE ISSUANCE OF THIS PERMIT+ ISSUANCE OF THIS PERMIT SHALL NOT
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0 MEOTO FY, WAIVE OR REDUCE ANY REQUIREMENTOF ANY CITY OR
EE 'ODI OVYEJON. I
ENFORCE ANY ORDINANCE PR
RECEIPT
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NOR LIMIT I N ANYWAY THE CITY'S ABILIT TO
TOTAL A.OUNTD E
IHERESY ACKNOWLEDGE THAT I HAVE INiA. THIS APPLICATtON; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS RR 'AND TH T AM W ORTH GUILY AUTHORIZED AGENT OF
`T`��COJTY"AENAD' ELAWS P E GU LAT I NO C ON S T RU C-
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CALL
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T H E OW N I AECT. � TO C.. pLy IN STATE
TION; AND IN DOING THE WORK AUTHOFFIZED THEREBY. NO PERSON WILL BE EMPLOYED
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FOR INSPECTION racolp! is acknowl,dgd I, sp,w pmvldod.
IN V'OLATIO F THE LABOR CODE 0 THE STATE OF WASHINGTON RELATING
DATE
WORKMEN'S DO ION INSURANCE AND RCW 18.27.
OFF ALSSIG USE
r7GNATj0I ATE SIGN
(425)
-/
771-0220
RELEASED ly DATE
— '7—
EXT 333
A17ENTION
3
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 -�NSPEC&Fl
ASSESSOR
A
BEEN GRANTED, LED SECTION 109
FAX
PINK - OWNER - GOLD -
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SPECIAL INSPECTION
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FINAL APPROVAL FOR
OCCUPANCY ...............
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7. 17,T�
ATE RECEIVED
:5�— PERMIT EXPIRES
us PERMIT
61TY OF EDMONDS ZO E NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITFJAPT#
ADDRESS 4& �/Z -.�7-
OWNER NAMEJNAME OF BUSINESS PLAT NAME/SUBDPH� NFI. f,,.T 111 NO,
cv0i e-
LID FEE S
MAILING ADDRESS
P BLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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CITY ITELE'"I
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REQUIRED DEDICATION FT
MET RSIZE ZE NO� OF FIXTURES
PRV REQUIRED
NAME
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YES 0 NO 0
FEES
REMARKS
OWNERtCOUfRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
Z
CIT ZIP TELEPHONE
NAME
13,6 0 U
ENGINEERING H—E.—DATE
ADDRESS
FIRE REVIEWED BY DATE
CITY ZIP LEPHO E
Z
0
VARIANCE OR CU SHOREUNE OR ADBO INSPECTI N So 0
REGO POSTED
CHECKED BY
STATE LICENSE NUMBER
OYES ONG
0
SEPAREVIEW �IGN AREA HEIGHT
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COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
TAX ACCOUNT 1111L
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REMARKS
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bGARAGE RETAINING WALL C3 RENEWAL
CARPORT ROOKERY
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FTYPE OF USE, BUSINESS OR AC`RVII Y) —LAIN: CHECKED BY T PE OF CONSTRUCTION
GROUP
NUMBER NUM EROF
SPECIAL INSPECTOR AREA OCCUPANT
OF DW LLIN
REQUIRED LOAD
YES
A m
o
STORIES UNITS
DESCRIBE WORK TO BE D0NEQeM*V IRY4,10YS
0
REMARKS
0
0
PROGRESS INSPECTIONS PER UBC 1081FINALINSIsbutlu.
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VALUATION FEE
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SOURCE LOT SLOPE %
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PLUMBING
m
_.ISTEDDATE
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE W RK NOTED. THIS PERMIT COVERS WORK TO
0
BE PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
'CUR... WAYS, MARQUEES, ETC.) WILL REQUIRE
a DOMAIN (C , SIDEWALKS, DRIVE
SEPARATE PERMISSIOW
U HARGE
P RMIT APPLICATION: U10 DAYS
E
PERMIT LIMIT. I YEAR ' PROVIDED WO AN IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEE S
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENG. INSPECTION FEE
'APPLICANT, ON BEHALF 0 HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAP NG
2 EDMONDS, WASHINGTON,'ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
INDIRECTLY
INSPECTION FEE
5 A CLAIMS FOR DAMAGESoF WHATEVER NATURE� ARISING DIRECTLYOR
OFTHI PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
FLALOM THE ISSUANCE
I ANY CITY ORDINANCE
DEEMED To MODIFY, WAIVE OR REDUCE ANY REQUIREMENTOF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAYTHE CITY-SABILITY TO ENFORCE ANY ORDINANCE PROVISION,-
T.TALA..UNT .. RECEIP
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
'i. S vz- APPLICATION APPROVAL
GIVEN ANDTHATA. THE NER. OR THE DULY AUTHORIZED AGENT OF
-DIRECT.
0 IS'
WITH CITY AND STATE LAWS REGULATING CONSTRUC
This Ippslafilft is 'Ft ' po,,jj u,t Isioned by th8
CALL hiMlh.l D.Pu,y: .�,I'F— ..pd—d
THE OWNER. I AGREE TO COMPLY
TION; AND IN 0 ING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
0 OF WASHINGTON RELATING TO
B016F, Offid.1 sl
FOR INSPECTION
IN VIOLATION OF THE LABOR CODE OF THE STATE
WORKMEN'S COMPENSATION INSURANCE AND POW IB�27
OFFICIALS SIGNATURE DATE
DATESIGNED
(425)
771-0220 DATE
EXT 333
9&v=kd
ATTENTION
IT IS UNLAWFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A A
771-0221 4NSPEcf A
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - 'ILE YELLOW.
GOLD - ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109
FAX PINK - OWNER
SAS