20020442.pdf—T DATE RECEIVED
PERMIT EXPIRES
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CITY OF EDMONDS IUMEIER�&,�W
CONSTRUCTION PERMIT APPLICATION JOB SUITEIAPT#
ADDRESS
OWNER NAMEANAME OF BUSINE S C —
, /— /,�p I S 1 PLAT NAMEISUBDIVISION N7 LOT No. LI NO.
MAILING ADDRESS LID FEE S
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PUBLIC RIG14T OF WAY PER I)IFIC111 STREET MAP n.s.-
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REQUIRED DEDICATION— FT — At.,,
;AME METER SIZE I LINE 11�1�, OF FIXTUR11 VSPRV SQUIRED
so No E3
REMARKS
ADDRESS 9 RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
CITY
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DESCRIBE WORK TO BE DONE
IREMA KS
PROGRESS INSPECTIONS PER USC 1081FINAL INSPECTION REOD
VALUATION $
Description F;EE;� Description FE
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Mechanical
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THIS PEFUll ;W-HORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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BE BONBON PRIVATE PROPERTY ONLY, ANY rONSTRUCTIO ONT CPU8LC
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Grading
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al
0 EQUI E
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3 OMAIN (CURBS. SIDEWALKS. DRIVEWAYS WILL
SEPARATEPERMi M4 U'ES'ETC
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Engr. Review
City Surcharge
P"MITAPPLICAIR N: IWIDAYS
PERMIT LUMBE I YEAR _ PROVID D WORK IS STARTED WITHIN ISODAYS
Engr. Inspection
State Surcharge
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SEE BACK OF PINK PERMIT FOR MORE INFORMATION
SUCCE ED..
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Traffic Mitigation
Plan Chk Deposit
IN INTEREST. AIMED To INIEMNIFY, DIFINI) AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS 0111CIALS, EMPLOYEES, AN AGENTS led. ANY A..
Fire Review
Receipt #
ALL CLA Me FOR DAMAGES OF WHATEVER MATURE, AR SING IRICTLY OR INDIRECTLY
U
I
FROM THE ISSUANCE OF THIS PERMIT SSUANCE OF THIS PERMIT SHALL NOT BE
Fire Inspection
TotalAmountDue
DEEMED TO MODIFY, WAIVE 09 REDUCE ANY REQUIREMENT OF ANY CRY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
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Landscapeinsp.1
Receipt #
I HERSEY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION
APPROVAL
GIVEN IS CO RECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
R
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULkTING CONSTRUC.
CALL
This appli—an Is not pem I until sigod ty th.
ouluityl:
TION; AND IN DOING THE WORK AUTHDRIZED'[HERE8Y. NO PERSON Wit L BE EMPLOYED
CDCE CE STATE OF WASHINGTON RELATING TO
FOR INSPECTio IN
Building Official of hislint, und F s. imild, shd
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
771-0221
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_INAPE'1-T0R
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
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