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PERMIT EXPIRES
'USE PERMIT
CITY OF EDMONDS ZON, S NUMBER2.0ol N-12-
CONSTRUCTION PERMIT APPLICATION JOB 7'TElAll-
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WNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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NAME
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VARIANCE OR CU SH07 OR ADB# INSPECTION IND
STATE LICENSE NUMBER EXPIRATION KEDBY STED
0 YERS�� NO
SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE I FXljPT ALLOWED , Pl��El ALLOWED PROPOSED
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REMARKS
PROGRESS INSPECTIONS PER UBC 108
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THIS PERMIT AUTHORIZES ONLY THEW RKNOTEG. THIS PERMIT COVERS WORK TO
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t: SEDONEONPRIV E PROPERTY ONLY ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURDS, SIDEWALKS, DRIVE MARQUEES, ETC.) WILL REQUIRE
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P. PERMITLIMIT.1 YEAR - PROVIDS) WORK IS STARTED WITHIN 180DAYS
ENG REVIEW FEES
SEE SACK OF PINK PERMIT FOR MORE INFORMATION
FEE
ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
ENG INSPECTION
;APPLICANT.
N INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
EGMONDS� WASHINGTON, ITS OFFJMALS� EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING 111PECTLY OR INDIRECTLY
INSPECTION FEE
—
RECEIP1
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
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DEEMEOT MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
ROMANCE PRO 0 '
NOR LIMI VIS' N"
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TOTAL AMOUNT DUE
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IHERE Y ACKNOWLEDGE THAT I HAVE BEAD THIS APPLICATION, THAT THE INFORMATION
1
APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT 01
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
CALL
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TION. AND IN BEING THE WORK AUTHORIZED THEREBY, NO PERSON WILL 11 EMPLOYTED
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IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RE LATING 0
FOR INSPECTION
WORKMENG G2WkNSA`BON INSURANCE AND RCW 18,27.
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SIGNATURTQ�NEI R AGE )ATE SIGNED
(425)
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771-0220
1 IL
RELEASFDJ�� DATE
A17ENTIOV
EXT 333
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IT IS UNLAWFUL TO USE 08 OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL "Ite- YELLOW. INSPECTOR
OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
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PLOT PLAN
Scale: I"= 20'-0" RECEIVED
MAY 3 1 2001
BUILDING DEPT.
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PROPOSED ADDITION MAIN FL. 450SF
PROPOSED ADDITION 2nd FL. 450SF =+10'
F ATTACHMENT A
EXISTING PATIO: 231SI +99,
EXISTING DRIVEWAY: 675SF C=+9w
D=+100'
23811 77th PL. W.
Height Calculation Worksheet
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Date:
Imector(s):
1. Datum Point: C—: Uw4\EA 2L kl&�
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2. Datum Point Elevation q7
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FINAL PROJECT "PROVAL FORM
TO:
DATE:
MEMO TO: PERmrr cooRDINAToi;� BUILDING DIVISION
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Date Sign_
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TO:—,
DATE:
MEMO TO: PERMIT COORDINATOlt, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
ENGINEERING DIVISION DATE Z
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