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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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STATE LICENSE NUMBER CHECK. BY
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NEW 0 RESIDENTIAL 01 .11-1.16
ADDITION 0 COMMERCIAL n COMPLIA CE OR
7 -DIAL CHANGE OF USE
C3 REMODEL APARTMENT SIGN
0 REPAIR 0 GRADING CYDE F NCS
X ITI
0 DEMOLISH 0 TANK OTHER
oGARAGE C] l'llTAjlll'NyG WALL RENEWAL
CARPORT F COX
NUMBER NUMBER OF '"IETAI,"L
DWELLING AR S
OF N.. ER
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DESCRIBE WORK TO 81 DONE
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PERMIT EXPIRES ��C)' �
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REMARKS
—PRI-NTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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LOT COVERAGE REOUIREOSETEACKSIT) ppOPOSED SETBACKS (FT)
ALLOWED PROPOS50 FRONT SIDE FEAR FRONT UR SIDE REAR
PARKING LOTAREA PLANNING REVIEWED BY DATE
PE R�UOTIONNI
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INSPECTIONS PER IUBC 1081FINAL INSPECTI
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PLAN CHECK FEE
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PLAN CHECK NO: ST5D DATE
PLUMBING
DO - 21A
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
MECHANICAL
BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC
"
GRADINGIFILL
JCURBS, SIDEWALKS, DRIVE S. MAROUEES, ETC.) WILL AEOUIRE
DOMAIN URB' WAY
M C 'R`EWA
SEPARATE PERMISSION.
ETATF� IURCHARGE
PE MIT APPLICATION:, 1-0 DAYS
P
PERMIT LIMIT. I YEAR . PROVIDED WORK S STARTED WITHIN 18D DAYS
A F_P'
E :
sI1,10. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
K oF P
-Oft INSPECTION FEE
b' -A PLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
'Fo'H
P Y OF
:ST.=.ETSGN). IN' DEFEND AND HOLD HARMLESS THE CIT
IN IMT�11. A. -
:TG�CMFIIGZALE. I PLOYEES, AND AGENTS FROM ANY AND
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mo AEH'N T N I
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LIC IMS F. DAM OFWHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FoRDAMAGES
-W ES
F E ISSUANCE OF THIS P.MIT ISSUANCE 01 THIS PERMIT SHALL NOT BE
P E U o
THE
M T
"or
PLAN CHECK DEPOSIT
I Y W UCE ANY HEOUIRENIENT OF ANY CITY ORDINANCE
DEEMED TO MODIFY, WAIVE OR RED
PROVISION
Non LIMIT IN ANY WAY THE DR Y 8 ABILITY TO ENFORCE ANY ORDINANCE
LIM T NY Y T
W
TOTAL AMOUNT DUE
I HERE Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
AUTHCTI,'�.Ell AGENT OF
GIVENB Co M T.E..VINER, OR THE CUSLY
IS FRECTiEANGC"ATPLA WITH 'TY AND STAT LAW FE.U' C.NSR
TO CIA I
CALL
THE OWN ' R. IAGF E.PLO'yU%
TION: AN IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE ATING To
REL
FOR INSPECTII
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON
W011MlITS COMPENSATION INSUIIANPE AND R W 11 7.
SIGNATURE DATE SIGNED
(425)
771-0220
ExT 333
A17ENTION
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. UBC SECTION 109
FAX
5198
APPLICATION APPROVAL
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ORIGINAL - FILE . YELLOW INSPECTOR
PINK - OWNER . GOLD - ASSESSOR
IIIIIIIII
RECORD OF INSPECTIONS
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PERMIT EXPIRES
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ALLOWED PROPOSED
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SIGN AREA
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EXP
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ALLOWED PR OPOSED
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LOT COVERAGE
PROPOSED
RECURS EET.AClr III
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CHANGE OF USE
DATE
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NUMBER
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NUMBER REQUIRED
INSPECTOR 11-
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DESCRIBE WORK TO BE DONE
a
REMARKS
INSPECTIONS PER UBC 1081FINAL INS PECTION REO'Dj
PROGRESS
LOT -SLOPE %
PLAN CHECK NO:
DATE
l'-so
THIS PERMIT AUTHORIZES ONLY THE �O.K NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAINi (CURB% SIDEWALKS, DRIVEWAYS. MARQUEES, ETC�) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATI N: 180OAY
I
PERMITUMIT.1 AR*P�ROVIDEDWOOKSSTARTE'DWITHtNi8iDAYS
YE
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
w 'A PLICANT. ON BEHAL OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUC ESORS
P
EBB THE CITY OF
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
5 WASHINGTONjITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANYAND
�DMONDS, TLYORINDIRECTLY
0.1,,WHATIVER,N ARISING DIREC
��,tSP ATURE,
NOT BE
.�'R,�.AMAGE,,,
g PPPMIT SSUANCE OF THIS PSAMIT,SHALL
ANY C Ty ORDINANCE
OINAN-1-1-1-
T.AT� All'EI_READ THIS APPLICATION; THAT THE INFORMATION
IHEREBY -E - OF
E OR THE DULY AUTHOR
S T � NO THAT AM OWNER, IZED AGENT
C"', I =LE'D
REGULATING C.NSTRUC-
THE OWNER, I AGREE TO COMPLY WITH CITY ANDSTATE LAWS
THEREBY, NO PERSON WILL BE EMPLOYED
TION, AND IN DO FIG THE WORK AUTHORIZED
THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
IN VIOLATION DIP
WORKMEN'S COMPENSATION INSURAN, ANDRCWIS.27.
SIGNATURE (OWNER OR A.IH�7)
I DATE lIGME
C,
U_) kL- L-
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
GRADINGIFILL
STATE SURCHARGE
REVIEW FEES
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
,CALL
. FOR INSPECTIO
(425)
771-0220
ATTENTION r-A 1 0"
IT IS UNLAWFULTO USE OR OCCUPY ASUILDING OR STRUCTURE UNTIL 771-0221,
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 10 FAX
VALUAtION FEE
ut
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