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PERMIT
CITY OF EDMONDS
NUMBER
CONSTRUCTION PERMIT APPLICATION
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'PROPERTY TAX ACCOUNT PARCEL NO,
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REMARKS
PROGRESS INSPECTIONS PER UBC 11081FINAL INSPECTIC
FEE
PLAN CHECK FEE
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BUILDING
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PLAN CtiECKdb
VESTED DATE
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVHERS WORK TO
a ONE ON PRIVATE , N E 'US "
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GRADING)FILL
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SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT APPLICATION: 18(l DAYS
PERMIT LIMIT'. I YEAR * PROVIDED WORK IS STARTED WITHIN 180 DAYS
IN. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLI ANT, E ALF F IS RHERSP SE�HER.A AND SUCCESORS
a
NIPY. DCFEN NO H L H�RIM ESS THE O'll —
I INTERE S T iNDF
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PLAN CHECK DEPOSIT
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T I A YTHECITY-SABI ITYT ENF E Y RDINANCE PROVISION.'
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I N LIMI
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TOTAL AMOUNT DUE
TER EBY L CGE THAT I HAVE READ THIS APPUCATIO� HAT THE INFO ATION
R 0 T UTN.R A.MENT Or
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CALL
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IN W LATI N F THE LA OR DE F THE STATE OF A:
FOR
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SIGN
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DATE SIGNED
(425)
771-0220
EXT 333
A! VE-
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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.
HAS BEEN GRANTED, UBC SECTION 109
FAX
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