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DATE RECEIVED 04 ERMIT EXPIRES
us PERMIT 787
CITY OF EDMONDS ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION 'AOD H E S S 621 6�4 A vc SUITEIAPT#
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'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND END ES.HS
�NDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY 01
IN INTEREST, AGREES TO
2 EDMONDS. WASHINGTON. TS OFFICIALS. EMPLOYEES AND AGENTS FROM ANY AND
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ALLCLAIMSPOR DAMAGES GFWHAlE
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cl DEI,MEU TOMODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
5 NORLIMIT IN ANY WAYTHE CITY S ABILITY TO ENFORCE ANYORDINANCE PROVISION
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFORMAHON
GIVEN 15 Col RECT� AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THE OWNER ' AGREE To COMPLY WITI 'CITY AND STATE LAWS REGULATING CONSTRUC
TION AND IN DOING THE WORK ALHFHOF�Z ED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN S COMPENSATION INSURANCE AN. RCW 18 2 '
=SIGNATUR=�Tl DAII SIGNED
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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-
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4� PLANNING DIVISION DATE—
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DESCRIPTION OF WORK TO BE INSPECTED__S��
A field inspection was conducted to determine compliance with approved plans. Final approval denotes that
there are no objections from the above signed Department to the granting of:
approval of the described work
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project Review Checklist
ProjectName:
Plan Check #:
Project Address:
Receipt Date:
Required
Underground Wiring
Hydraulics Permit
Plat/Subdivision Requirements
Street Dedications
Easements - public/Private
Engineering Storm Drain Review Feel
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Engineering 2.2 Inspection Fee
Drainage Plan (On -site) 5-0-115
Setback - Storm Drain Line
Open Ditch - Existing
Culvert Required
Culvert Size
Shoulder Drainage/Shale Open Runoff
Catch Basin Required
Driveway Slope & Vehicle Access S. 00- IG
sidealkRequired 5-W-16-
Curb & Gutter RequirecIS-00. tV
Curb Cut for Driveway Required S-00-09
Street Paving Required
Right-of-way Construction Permit Required VC5
Bond Required for Public Improvements Mo
FEMA map Check/Water Table
Side sewer Availability Va.5
Calculate Sewer Fee if No LIN
Water Meter Size
Water Meter Charge Required
Hydrant Required
Street Cut
Miscellaneous
RW Permit #
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DATE RECEIVED
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I DOMAIN (CURDS, SIDEWALKS, DRIVEWAYS' MARQUEES, ETC.) WILL REQUIRE
:3 SEPARATE PERMISSION
t STATE SURCHARGE
PERMIT APPLICATI N: 1110 DAYS
PERMIT LIMIT: I YEAR. PROVID D WORK IS STARTED WITHIN 180DAYS ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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;APPLICANT. ON BEHALrOF HI S ORHE SPOUSE. HEIRS, ASSIGNS AND SUCCESOAS
N NTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
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T FROM THE ISSUANCE Or THIS PERMIT. ISSUANCE OF THIS PERMIT,SHALL NOT BE PLAN CHECK DEPOSIT!
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NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' RECEIPT
TOTAL AMOUNT DUE
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IHEREDY ACKNOWLEDGE THAT' HAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVEN I CORRECT, AND THAT I A. THE OWNER OR THE DULY AUTHORIZED AGENT 01 t:,
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRILC
S CALL Budd,,,o Olf.—I .1 DKIWY: ,d Flo, lPP11d. and
TION, AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED d
0 CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION ,,pI.k1l1Ildg,d,,, IF— P-
IN VIOLATION OF THE LAB A
WORKMEN'S COMPENSATION INSURANCEAND RCW 1B.27. DATE
OFFICIALS SIG�_hLURk
NATURE (�nAGENT) ;IGNED (425) )CII,
_rE 771-0220 EtEASEGBY
ATTENTION' OR STRUCTURE UNTIL EXT 333 L-./
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL FILE - YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK OWNER - GOLD - ASSESSOR
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