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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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MAILING ADDRESS
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NAME
PERMIT EX
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ON. 'NUMBER A06751341
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PI -AT NAMDSUBDIVISION No. I LOT NO. 41D �o.
LID FEES
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP 1ESCPA
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EXISTING — PRoPoS11--
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s E3 NO 0
R MARKS
—NERICONTRACTOR RESPONS18LE FOR EROSION CONTROUDRAINAGE
ENGINEERING REVIEWED;DATE
51RE REVIEWED BY DATE
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REMODEL APARTMENT SIGN
RECIPA I PROVIDED
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REPAIR CYDS x FT)))))
ARKS
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(TYPE OF USE. BrSS OR CTIViTY) EXPLAIN:
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NUMBER OF
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NUMBER
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DESCRIBE WORK TO BE DONE
EMARKS
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require
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PLAN CHECK NO:
PLUMBING
IVESTED
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WENES
W
-
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
1: 11 DONE ON P1111 PROPERTY ONI ANY CONSTRUCTION ON THE PUBLIC
GRADINGIRLL
WAY
D.MAIN (CURBS. SIDEWALKS, DRIVE S, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
S TATE SURCHARGE
PS. MITAPPLICATIoN: 18DDAYS
PERMIT LIMIT, 1 YEAR PROVIDED WORK IS STARTED WITHIN 180DAYS
G RE 'EW FE
ENG. REVIEW FEES
SEE BACK F PINK PERMIT FOR MORE INFORMATION
PLICANT, ON BEHALF OF HIES OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
,P To
ENG. S ECTit N FEE
G � .. ON
,P S To �ND MNIFY. DEFEND AND HOLD HARMLE THE CITY OF
;A AGREE IS
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OM ANY AND
EDINTEREST.
MCNOS WA HINGTON. TS OFFICIALS, EMPLOYEES, AND AGENTS FR TLY
ALL C IMS FOR DAMAGESOF WHATEVER NATURE. ARISING DIRECTLY OR INDIREC
LA
4EN
I I
TEVE I _�T
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL No T BE
LAN K DEPOSIT
PLAN K DEPO IT
EEMED TO MODIFY, WAIVE OR REDUCE A Y REOUIREMENT OF ANY CITY ORDINANCE
ANY ORDINANCE PROVISION.'
DNOR
TO ENFORCE
LIMIT IN ANY WAYTHE CITY'S ABILITYN
TOTAL AMOUNT DUE
H1,
n, ��6 I
'HEREBY ACIN.�LEDGI THAT' HAVE READ THIS APPLICATION: 1HATT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT, ANC
HEDWMER OR THE DULY AUTHORIZED AGENT OF
T IPP11-111 11 - A P11111 -il 119— by Ihl
T ED NER. I AGREE TC . WITH Ty AN6 STATE LAWS REGULATING CONSTRUC -
:CTHAT'LAM
CALL
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N; AWND IN DOING THE No PERSON WILL BE EMPLOYED
I WORK AUTHORIZED THEREBY.
N OF WASHINGTON RELATING TO
.P, Idgld 11 P—d-
S s
F OR INSPECTION
DILATION OF THE LABOR CODE OF THE STATE
o KMEN'S COMPENSATION INSURANCE AND RCW 18.27.
CIALS SIGNA DATE
SIGNA URE(O NE A NTj DATE 1IGNE o
(425)
�J7771-0220
1ELEASED BY' DATE
/ATTENTION
hx 11;33J
ITISUNLAWFULTOUSEOR OCCUPY A BUILDING OR STRUCTURELINTIL
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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PARKING I
LOT AREA PLANNING REVIEWED B
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NUMBER
IN MBER OF
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GLAZING % L2T SLOPE %
PLAN CHECK NO: IVESTID DATE
FT;; p,,�...,T AUTP".ORIIES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
BE. .. VATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
SIDEWALKS, DRIVEWAYS ETC.) WILL REQUIRE
..�IMARQIJEES,
SEPARATEP SSION.
STATE SURCHARGE
PERMIT APPLICATION: DAYS
SIM,
PERMIT LIMIT. I YEAR - PROVIDED WORK I STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
THE CITY OF
ENG NSPECTON FEE
;APPLICANT,
13 N INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS
AGENTS FRO. ANY AND
I EDMONDS, WASHINGTON, ITSOFFICIALS. EMPLOYEES, AND
OFWHATEVER NATURE. ARISING DIRECTLY 0
I ALLCLAIMS FOR DAMAGES INDIRECTLY
5
PRO THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SMALL NOT 85
F
DEEMEDT MODIFY, WAIVE OR REDUCE ANY REQUIREMENT 0 ANY CITY ORDINANCE
-
NO A LIMIT ION ANYWAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THE OWNER. 'AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
T ' DOING THE WORK AUTHORIZED THEREBY NO PERSON WILL BE EMPLOYED
I , NO
I\ 'A 'IN RE ATI To
OF
FOR INSPECT11
IN IbL'AT ON OF THE LABOR CODE OF THE STATE WASHINGTON
C
K OMPENSATION INSURANCE AND PCW 18.27.
W W. KNIEN�S C
SIGN DATE I INID
A
(425)
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77-1-0220
EXT1333
A TT ENTION
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. LED SECTION 109
FAX
T"'Ph""". is not . hnit .101 ,glad by the
BtIddln, OIII.IdI -1 hl,Mo' Deputy; and Fee, — paid, and
,m,lpt I a .'tih.,jldgodl In tpa.0 phI
IFICALS SIGIIAJURE _ DATE
ORlaINAL-FL9 YELLOW -INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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