20010803.pdfDATE ........
67
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNERNAMEANAME OF 8ZIN SS
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DATE
FIRE REVIEWED BY
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INSPECTION BOND
VARIANCE OR CU SHORELINE OR ADS#
RE,�D POSTED
STATE LICENSE NUMiBER
E3 YES 13 No
SEPA REVIEW SIGN AREA EIGHT
PROPERTY TAX ACCOUNT PARCEL NO.
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LLOWE
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CCUPANT
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REMARKS
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PLAN CHECK NO: 5
/ (
VESTED DATE
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MECHANICAL
THIS PERMIT AUTHORIZES ONLY TH E WORK NOTED. T PERMIT COVERS WORK TO
8 EIN PRIVATE F-PCFTY ONLY AN, CONSTRUCTION ON THE PUBLIC
D NE
GRADINGIFILL
DE SI E LKS D""WAS� MARoUEES. ETC.) WILL REQUIRE
OMAN B W�SEPARATE
PERMISSION.
STATE SURCHARGE
PER MIT APPLICATION: Iso DAYS
I
PERMIT LIMIT: I YEAR - PROVIDED WORK S STARTED WITHIN 18D DAYS
END REVIEW FEES
SEE BACK OF PINK PERMIT FOR MGRE INFORMATION
END INSFECTIOt4 FEE
-APPLICANT. ON BEHALF OF HIS OF HER SPOUDSE, HEIRoLDE St NSANDSUCCESORS
( EFEN �NHDEIH
IN NTEREST AGREES TO NDE.NI . H LD AR LESS I HE CITY or
AN A ENIS IF . ANY AND
ANDSCAPING
INSPECTION FEE
EDNONDS.WASHINGTOIN. HrsOFFIC`l LS. EMPLOYEES,
ORINDIFECTLY
NATURE. ARISING DIRECTLY OF INDIRECTLY
R
AILLCLAIMSFQkDANAGESOFWHATEVE"
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PER.IT s-L NOT BE
PLAIN CHECK DEPOSIT
DEEMED TO MODIFY, WAIVE OR REDUCE AN Y REOUREMENT OF ANY CITY ORDINANCE
o NOR LIMIT INANYWAYTHE CITY S A81LIly TO ENFORCE ANY ORDINANC
OUNT DUE
TDTAI_ AMOUNT DUE
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFORMATION
GIVEN I CORRECT. AN. THAT I A. THE OWNER. OR THE DULY AUTHORIZE. AGENT OF
5
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THEOWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATIN51ECEMIPSLTO�Y�E`�
CALL
TION AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL
WASIIN.TON RELATING TO
FOR INSPECTION
IN VIOLATION OF THE BOR CODE OF THE STATE 01
OLA
WORKMENSCO E R,U,CE AND RCW 18,27
(425)
GNAT 9 1 ENT)
DATE SIGNED
0
771-0220
EXTJ333
TTENTION
IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
IT
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFi-
A FINAL
HAS BEEN GRANTED. UBC SECI ION 109
FAX
CATE OF OCCUPANCY
"e
VALUATION I FEE
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RECORD OF INSPECTIONS
INSPECTOR DATE APP ROVED
SETBACKS ...................
FOUNDATION:
�3,
Footing ......................
wall ..........................
Pier/PoTch ...............
Retaining Wall ...........
Slab Insulation ..........
P LUMB11,11r.:
om
Uncierground .............
Rough -In ..................
Commercial Final
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Gas Test ............
Gas Piping ............
Equipment .................
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INSULATION ...................
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SHEETROCK NAILING
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SPECIAL INSPECTION
IV
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
PERMIT EXPIRES
PERMIT
CITY OF EDMONDS NUMBER
SUIT&APTA
CONSTRUCTION PERMIT APPLICATION 'ADOORESSS)03 t-f( J()cll� Lanc—
OWNER NAMEMAME OF BU [NESS FIAT MU v IoN LOT NO. LID NO.
q li )� ('IS+ I ciz ;rclg �4411 � LID FEE $
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CITY ZIP TELEPHONE
c—cl 1-1 oll cis 02 METER SIZE LINE SIZE NO. OF FIXTURES PRY REQUIRED
NAME YES 0 NO C3
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PROPERTY TAX ACC LINT PARCEL NO.
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VALUATION FEE
PLAN CHECK FEE
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DATE
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THIS PERMIT AUTHORIZES ONLY N E N.LRYK N..YTB. ISUPERIMIT COVERS WORK TO
E W . � ;H UBLIC
PROPERTY C 14 TR CTIONONTHEP
t!
M
BE DONE ON ."A .
U
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS' MARQUEES ETC)MLLFIEG IRE
SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT APPUCATION: 110 DAYS
PERMITUM PROVIDED WORK S STARTED WITHIN 160 DAYS
F PINK PERMIT FOR MORE INFORMATION
ENG. REVIEW FEES
S OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
;APPLICANT, 11 FIN'41VINIFY, DEFEND AND HOLD HARMLESS THE C111 Ul
ENG, INSPECTION FEE
LANDSCAPING
m
N:NTEREST.
EDMONDS, A
GEi;OF EVER URE,A I'IN IRECTLYORINDIRECTLY
IN5PECTIONFEE
RECEIPT
A C 1 5 R A
SUANCE OF THIS .. PERMIT. ISSUANCE THI PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
F E I
D EMEOT DLFY, AIVE A REDUCE ANY REQUIll E ENT F ANY CITY ORDINANCE
RECEIPT
N RLI iT'I ANY THECI SABILITYTOENFO E NY R
TOTALAMOUNT UE
IT I HAVE READ THIS APPLICATION. THAT THE INFORMATION
THA
APPLICATION APPROVAL
IHEREB 'Y OU
GIVEN S =LIEAD.GD THAT I AM THE OWNER. OR THE LY AUTHORIZED AGENT OF
Thl, pplaan j, not A pannil unfil signed by thO
TE S REGU TING CONSTRUC
THEOWNE IA FEET COMPLYWITH CITY S LOYED
ILL BE
CALL
odd goff,6alorhi-01 ap,ty:,,d F40 pa,d. and
0
.d.
I ORK AUTHORIZED THE E Y, PERSON LEMP
TION NO NO
ASHINGT N RE ATING�JO
FOR INSPECTION
F
IN Vi TI F THE BOR CODE OF TH S E F
16.27.
OFFI LS S16PATUR DATE
WOFt EN'S ' E I RANCEAND
ENT)
DATE SIGNED
- 1425)
GRAY E I
771-0220
BY
ASED
EXT1333
ENTiON
ITISUNL FUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
AW
771 �0221
I
a F'NAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI
ORI INALtFILE YELLOW-INSPECTO
GOLD -ASSESSOR
CAT I OF OCCUPA�JCY HAS BEEN GRANTED. LIED SECTION 109
FAX
PINK OWNER
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