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CITY OF EDMONDS
PERMIT zc'� M5
NUMBER
CONSTRUCTION PERMIT APPLICATION JOB
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OW
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W�L- CYD.#'V--E- (_X_")
REMARKS
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NUMBER NUK45ES OF CRITICAL
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PLAN CHECK NO: 913DATE
BUILDING
PLUMBING
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I:, BE DONE ON PRIVATE PROPERTY 011- ANY CONSTRUCTION ON THE PUBLIC
S SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
L
GRAD1111FILL
STATE SURCHARGE
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT. I YEAR, PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEEBACK OF PINK PERMIT FOR MORE INFORMATION
,w ;APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AN. SUCCESORS
�j N INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FRO. ANY AND
m CLAIMSFOR AMAGESOFWHATEVEI. Y
ALL 0
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDI NANCE
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION�
ENG. REVIEW FEES
IN . PEG RON FEE
PLAN CHECK DEPOSIT
TOTAL A OUNT DUE
REG IPT
0,13
R FT
I HEREBY ACKNOWLEDGE THAT I HAVE READ TH15� APPT'GATR.'Ny. THAT .HE -I.A. TIDY
GIVEN IS CORRECT, AND THAT I AM THE OWNER . HE DR AUTH R'Z'D AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
TIONL AND IN 00 NG THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE E.ILOYEO
I RELATING TO
I N VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON
_S�URANCE AN RCW IS 21
_9� NICE AN
WORKMEN'S qOMPENSATI I I —
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APPLICATION APPROVAL
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(425)
771-0220 E SED BY DATE
_�j�ENTION_ 7' EXT1333
IT IS UNLAWFULTO 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. USC SECTION 109 FAX
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Project Review Checklist
!S;n I L--Z—
Plan Cheek#:
P roject Name:
Project Address* Z(
Receipt Date:
Underground Wiring Required
Hydraulics Permit
Plat/Subdivision Requirements 147
Street Dedications
Easements - Public/Private 7
Engineering Storm Drain Review Feel
Engineering 2.2 Inspection Fee
Drainage Plan (On -site)
setback - Storm Drain Line
open Ditch - Existing
Colvert Required
Culvert Size
Shoulder DrainagetShale Open RA�ioff
Catch Basin Required
Driveway Slope & Vehicle Access 410".
Sidewalk Required lz--fie-7
Curb &Gutter Required i00
curb Cut for Driveway Required
Street Paving Required
Right -of -Way Construction Permit Required A)b
Bond Required for Public Improvements Oo
FEMA Map Check/.Water Table
Side Sewer Availability 9Z-f-/'7
Calculate Sewer Fee if No LID#
Water Meter Size,
7,Q1
Water Meter Charge Required
Hydrant Required
Street Cut
Miscellaneous
RW Permit # Date Issued
Receipt #
-7
Receipt
SS Permit # !39 Date Issued
A Tbo ,
Meter Size Paid $
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Date" —101 Receipt#/
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AISH COUNTY, WASHINGTON
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EFFECT AT THE DATE A COMPLETED
WITH THE ORDINANCE IN
PERMIT APPLICATION Is Tommm To THE CITY OF
BUILDING
EDMONDS.
20 15i
THE PLACEMENrOF DRIVEWAY ON LOT FOUR SHAM BE 1.111078D TO
113 oP LAST PROPERTY LINE,
—Its. .
M>UYBERN
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THE CONSTRUCTION OF A FIVE-FOOT ASPHALT StDEWALX ACROSS PARX
ROAD FRONTAGE OF LaM TWO AND THREE IS DEFERRED UNTIL ISSUANCE
OF ,.BIG . ON T...
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VERTICAL
WA
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CURB AND SMEWAL)L
LOT ONE TO ACCESS 92ND PLACE WEST "'TH NEW DMMAY.
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INSPECTOR DATE APPROVED
SETBACKS ...........
FOUNDATION: 5oi(-
7J�J-
Footing ...................... 6y ocv r
Wall ...........
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Pier/Porch .................
Retaining Wall ........... 0
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FRAMING ........................
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FINAL APPROVAL FO
OCCUPANCY ..................
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US PERMIT 7�7
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CONSTRUCTION PERMIT APPLICATION JOB SUITEJAPTA
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-AT
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0
Ilp TELEPHONE
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CITY
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ME 0. OF j1qAEE
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ILI FOR EROSION CONTROUDRAINAGI
OWNESICONTRACTOR RESPONSISL FOR EROSION 00 OUDRAINAGE
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NA
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PROPERTY TAX ACCOUNT PARCEL G.
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REMARKS
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NUMBER BER
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DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC1 o8fFINAL INSPECTION REO'D a
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PIA &L
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THIS PERMIT AUT1101,117E ONL HE WORI OTD THISpBMIT�.Cov.ER1 WORKIO
BE .. E ON P., 'IT S R. YT Ty ONLY "NY C .. T UCT. N NT PUBLIC
E A PE
"L.Eauine
GRADINGWILL
L S AR.UEE.,ET
(CURB., B, E. K
B E "AT, E R.KS�'G.
L
STATE SURCHARGE
2 PE MIT APPLICATION! 180 DAYS
I
PERMIT LIMIT'. 1 YEAR - PROVIDED WORK IS STARTED WIT HIN 180 DAYS
ENG. REVIEW FEES
SEE SACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUS I E. HEIRS, ASSIGNS AND SUCCESOAS
IN INTEREST, AGREES TO INDEMNIFY, DE NO Ayl HOLD HARMLESS THE CITY OF
" OM ANY AND
EEE.ANDAGENTSFR
ENG. INSPECTION FEE
�LANBS Pl—
NSR-6
r
EDMONDS. WASHINGTON, ITS OFFICIAL', EMPLIT
IF ALL CLAIMS FOR I1AMAO11OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
OF THIS PERMIT SHALL NOT BE
RECEIPT
PLAN CHECK DEPOSIT 3
F -1 ANCE HIS PERMIT S,UANC
ROM THEIS U Y OF T OF EDUCE REQUIREMENT OF ANY CITY ORDINANCE
-EE.E.T... IF �WAIVE T ANY F NCEPROVISION'
N ITI.AN E SAGIL, YTOEN OSCEANYORDINA
OR L, YVV Y T. CRY�
R El T
TOTAL AMOUNT DUE
ApPTLIHCATIOLNY TH T THE 0 MAT ON
AUA INF R I
I HEREBY ACKNOWLEDGE THAT I HAVE
on E DU THOPIZED AGENT OF
PPLICATION APPROVAL
JRFOAWDTHI�S
GIVEN I CORRECT. AN THAT I AM TI- E HE I
AGREE DULA ING cONsTRuc-
THE OWNER. I T WITH CITY AND STA E LAW FIE
0
T
C!%LL z . """D
S.ij ffi'�-
LLD Em DYED
TION; AND IN DOING TH EWCOORMKPAUT14 RIZED THE EBY . No PERS N wiT
RATET F WAS MONCTON RELATpjNG To
0 S
FOR I ECTION —op, I,
NSP
IN VIOLATION OF THE LABOR CODE OF TH F ST
WORKMEN'S COMPEN:=RANCE AND RCW 18.27,
. 41 All
!TFI, ALS XIGIVATU,
SIGNAT ENT) DATE SIGN
(425)
771-0220
7�` 7—
EXV333
ENTIO
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL a /1'� a
HAS BEEN MADE AND APPROVAL OR A CERTIFI. 771-0221 ORIGINALIFILE YELLOW. INSPECTOR
7
A FINAL INS PECTION
UBC SECTION 109,
PINK - OWNER COLD - ASSESSOR
FAX
CATE OF OCCUPANCY HAS BEEN GRANTED.