20020407.pdfOW DATE RECEIVED
PERMIT EXPIRES
CITY OF EDMONDS ZU04ENE ERM T
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CONSTRUCTION PERMIT APPLICATION JOB SUITEIAPT#
ADDRESS 191 39AI-'I """' PL -�)i
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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STATE LICENSE NUMBER EXPIRATION DATE CHE D Y
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0 NEW RESIDENTIAL PLUMBING MECH
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REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT)
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REMARKS
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GARAGE RETAINING WALL
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REMARKS
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Description
FEE Description FEE
IN) J-Trj� jlf�tl_
Plan Check
H= LOT
Building
PLAN CHEC22L
Plumbing
THIS PERMAr AUTHORIZES ONLY THE W6RK NOTED. THIS PEnmrr COVERS WORK TO
Mechanical
t BE DONE ON PRIVATE PROPEFITY ONLY. ANY CONSITILICTION ON THE PUBUC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS MARQUEES , ETC.) WILL REQUIRE
Grading
Recording Fee
SEPARATEPERM;SSION.
Eng, Review
City Surcharge
PERMIT APPLICATION: 180 DAYS
PERMIT UMM I VEM. PROVIDEDWOR ISSTARRIEDWITHU4 INDAYS
SEE SACK OF PINK PERMIT FOR MORE INFORMATION
Engn Inspection
state Surcharge Z�/ 60
F
'APPLICANT. ON 11HAU` 0 HIS Oil HER SPOUSE. HEIRS. ASSIGNS AND 1UOCE1OR1
Traffic Mitigation
Plan Chk Deposit
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON. ITS
OFFICIALS, EMPLOYEES. AND AGENTS FROM ANYAND
ALLCLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Fire Review
Receipt,#
FROM THEISSUANCE OF INIS PERMM ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY. WAIVE OR REDUCE MY REOUIREMENT OF ANY CITY ORDINANCE
Fire Inspection
TotalAmountDue 7z.
NOR LIMIT IN ANY WAY THE Drive ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
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Landscape Insp.
Receipt #
I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THENOMT,.N
GIVE" 19 CORRECT.AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
— -
APPLICATION APPROVAL
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
application Is not a pans'lool"sig,odbyVal
TION; AND,IONNOOOIFNTGHTH:nAUT...,I�E. THERE- No PERSON WILL BE EMPLOYED
Sull-ftils
da,901ficim.11calhorDe 11y; and F11sm paid. and
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IN VICLAT E Jon DOE . E
I FUi TH STATE OF WASHINGTON RELATING TO
WORKMEN�SCOMPYP FNIN RANCE�AN,411cwlll.27.
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FOR INSPECTION 01ra 11 acknos,lodged In space proldd.
SIG E DATE SIGNED
(425)
OFFIIIIIALS SIGNATURE DATE
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&1� -I& -,I 1.4h 41�_/) 111
771-0220
RELEASED BY 'DATE
ATTENTION'
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
9INAL
771-0221
Ll
4ni—yt.
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
E OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK, OWNER - GOLD -ASSESSOR
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