20020139.pdfDATE RECEIV7
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PERMITEXPIRES
CITY OF EDMONDS
PNEuRmmi'EqAW�&S
CONSTRUCTION PERMIT APPLICATION
JOB SUITEIAPT#
ADDRESS
ER NAMEINAME OF BU 91NEST
FLAT NAMEISUBDIVISION NO.
LOT No'
LID NO.
LID FEE
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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REMARKS
OWNEFUCONTRACTOR RESPONSIBLE FOR EROSION CONTROVIDRAINAGE
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NAME
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FIRE REVIEWED BY DATE
STATE LICENSE NUMBER EXPIRATION DATE
VARIANCE it ou
SHORELINE OR ADB#
INSPECTION
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OSTED
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PROPERTY TAX ACCOUNT FAR—_
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SIGN AREA
ALLOWED , PROPOSED
HEIGHT
ALLOWED PROPOSED
NEW rl RESIDENTIAL N,>.N
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (F0
FRONT SIDE REAR
o 0 SETBACKS (FT.)
PR POSE
FRONT URSIDE REAR
ADDITION o G BROM, C MPLIkNCE OR
OMM L CHANGE OF USE
REMODEL 10� APARTMENT SIGN
PARKING
REQ?II I PROVIDED
LOT AREA
I PLANNING REVIEWED BY DATE
o FENCE
0 REPAIR [3 GRADING CYOS ( — X FT)
REMARKS
0 DEMOLISH 0 TANK 0 OTHER
o GGARAGE ETAINING WALL
ARPORT 13 BROOKERY [3 RENEWAL
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DESCRIBE WORK TO BE DONE
REM RKS
PROGRESS INSPECTIONS PER USC 108/FINAL INSPECTION REOD
Description
FEE
Description
FEE
Plan Check
77—
LOT SLOPE %
Building
PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLYTHE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
a
Grading
Recording Fee
3 DOMAIN (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
t: SEPARATE PERMISSION.
2 —
PE MITAPPLICATION: INDAYS
Engr. Review
City Surcharge
PERMIT LIMM I YEAR -PROVIDED WORK IS STARTED WITHIN 180DAYS
Engr. Inspection
State Surcharge
EEBAC F PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
Traffic Mitigation
Plan Chk Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
as
EDMON HINGTON ITS OFFICIALS, EMPLOYEES. AND AGENTS FRO ANYAND
Fire Review
Receipt #
ALL CLAIN14FAOSR DAMAGE� OF WHATEVER NATURE. ARISING DIRECTLY ORMINDIRECTLY
FROM THE I SUANCE OF THIS PERMM ISSUANCE OF THIS PERMIT SHALL NOT 86
DEEMED TO MODIFX WANE OR REDU BABY REQUIREMENT OF ANYC ORDINANCE
ITY
Fire inspection
Total Amount Due
NOR LIMIT IN ANY WAY THE CRTYS ABILITY TO ENFORCE ANY ORDINANCE ON.
PROVISI
Landscapalrep.
I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THE OVANEFL I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC�
CALL
This spiriketion Is not a pennil,nfil signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATIO 0 HE LA OR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
1,11ding ORKI.I., Welh., Deputy: and Bases. Find.
'ecelpt Is acknowledged 11 SPOIC PmIded.
WORKMENIS ATION INSURANCE AND NOW 18.27.
NATU DATE
SIG���� SIGNED
(425)
AII
771-0220
—
ATTENTION
EXr 1333
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-
ORIGI AL. FILE YELLOW- IIIIAPECTdl
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER - GOLD -ASSESSOR
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