20020611.pdfDATE 110111111
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER �.A.V.A.. OF
MAILING ADDRESS
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STATE UCENSE NUMBE
EXPIRATION DATE
;I 1PRWERTY TAX —ACCOUNT PARGEL NO,
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ADDITION
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171 CHANGE OF USE
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[:] SIGN
REPAIR
GRADING CYOS [3 FE CE
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DEMOLISH
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OCKERY
0 FIR SPRINKLER
FIREALARM
OWE OF USE, BUSINESS
NUMBER
OF
STOR
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NUM ER OF
D WELL No
UNITS
ZRITICAL
AREAS
NUMBER AML
DESCRIBE WORK TO BE DONE
[�P�ERMITPIRES
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JOB SUITEIAPT#
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PLAT NAMFJSUDDIVISION NO. I LOT NO, D NO.
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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REQUIRED DEDICATION— onsons—
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FEE
Description
FEE
Plan Check
State Surcharge
I%
GLAZING % LbT SL 0
Building Permit
City Surcharge
PLAN CHECK NO: .... ...
V ESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLYTHe WORK NOTED. THIS PERMITCOVER WORKTO
BE DONE ON PRIVATE PROPEFRIV ONLY. ANY CONSTRU IONONTHEPUBLIC
DOMAIN
Grading
(CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC WILL REQUIRE
SEPARATE PERMISSION,
PERIWTAPPLICATI N: 1NDAYS
Engr. Review
PERMIT LIMIT. I YEAR PROVIDED WORK IS STARTED WITHIN ISODAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICAW. ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
Fire Review
Plan Chk, Deposit
10MOND1, WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapeinsp.
Total Amt, Due I 7zz
0 NOR LIMIT IN AM WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Recording Fee
Receipt # I 1�b3q S
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUT140H ZED AGENT OF
APPLICATION APPROVAL
THE OWNE . I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUG.
CALL
parnift-fillignedbyft
TIGN; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
VIOLATION OF THE LABO THE ST�E OF WASHINGTON RELATING TO
FOR INSPECTION
sid,Thisapplicn,flools-I
Meg OM W or hisiher Darns, and Fees are paid, Ind
'leopt is nknowledged [,,pace provided,
WORKMEYS COMPENSAT AND RC 18,27.
$OWN�R 0 —1 SIGNED
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OFFICIALS DAT
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-ATTENTION
Off 1333
RELEASED BY'
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
ORIGINAL - FILE . YELLOW. INSPECTO
PINK - OWNER GO D,ASSESSOn
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN ACCOUNTING
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Footing ..............
wait ...........
Pier/Porch
Retaining Wall
Slab insulation ..........
PLUMBING:
Underground .............
Rough -in . ..................
Commercial Final
HEATING:
Gas Test ................
Gas Piping .................
Equipment ..........
Commercial Final
EXTERIOR SHEATHING
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