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STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY
VARIANCE OR CU
SHORELINE OR ADB# INSPECTION BOND
REOG POSTED
E3 YE. IB'Ki6
ITTY TAX ACCOUNT PARCEL NO.
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COMPLETE IX ALLOWED PROPOSED A�7WII *111
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NUMBER I NUMBER OF 1--6R-ITICA
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DESCRIBE WORK TO BE DONE
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VALUATION $
Description
F�E Description FEE
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Plan Check
3
LOT SLOPE %
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Building
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-VIESTED DATE
Plumbing
THIS PERMITAUTHORIZE so' RMIT COVERS WORKTO
Mechanical
t BE DONE ON PRIVATE PROPERTY ONW. ANY CONSTRUCTION ON THE PUBUC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
Grading
Recording Fee
SEPARATE PERMISSION.
Engr. Review
City Surcharge
PE?MfTAPPIJCATION1 180DAYS
PERMITLIM1,111YEAR PROVIDED WORK IS STARTED WITHIN —DAYS
Engr. Inspection
State S.rcha,
SEE BACK OF PINK FERMIT FOR MORE INFORMATION
'APPLICANT, ON HEHALF,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
EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AN AGENTS ISO. ANY AND
Fire Review
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE I SU.ANCE OF S PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TOS20IFY. WAIVE R REDUCE ANY REQUIREMENT OF My CITY ORDINANCE
Fire Inspection
-unt Due
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Landscapainsp.
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
-
APPLICATION APPROVAL
GIVEN 18 CORRECT; AND THAT I AM THE OWNER, 09 THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
Thi-ppil.11- 1. t. p-11 �Mil �Ig..d by ft
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON REILATING TO
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FOR INSPECTION .. feeciplisocknmiodg,�dl,,.p.,.p,.,id�d.
WORKMEN'S COMPENSATION INSURANCE AND RCW 0.27.
DATE SIGNED
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(425)
F
0 OF LS SIGNATU6 DATE
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031-0 �-- / , ,j_
1 771-0220 G BY IIIATE/
ATTENTION
TO USE
M 1333
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�YELL.
IT IS UNLAWFUL OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
.I...L - FILE
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109
FAX
PINK - OWNER GOLD - ASSESSOR
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PARCEL*: 0055-880-000-1000
51TF PLAN 20830 80th PLACE WEST
SCALE: I' = 20' EDMONDS, WA
APPROVED AS NOTED
BY.ENGINE
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Date: ShOos
+ 2.5' 100, + a
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80th PLACE WEST
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ADDITIOM
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APPROVED By PLANNING
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SETBACKS* ---------
SIDE
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OTHER
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FOR
IMPERVIOUS SUFFACE CALC
IS RE"SIBLE
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EX�5TING BUILDING:
1211 SOFT.
osl(OOITMOL ANt) oRAINAGE
EX ST NG DRIVEWAY;
I-ROP05ED ADDITION;
785 SOFT.
-49rBQFT9U
TOTAL:
1145 SOFT
+ 2.5' RECEIVF-D
LOT AREA:
83SI SOFT.
COTT V_-- 14AR - 5 2002
LOT COVERAGE:
1
20.8%
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DATE:
M[EMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE—
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