20020725.pdfI
DATE RECEIVED
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PERMIT EXPIRES
CITY OF 7DIVIONDS
CONSTRUCTION PERMIT APPLICATION
USE PERMIT
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NUMBER
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ADDRESS
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION— FT
TESCP Approved
RW Permit Required
street use Parm" Raq d
Inspection Required 13
Sidewalk Required 13
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Wiring required 13
CITY ZIP
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REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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ITELEPHONE
NAME
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PROPERTY TAX ACCOUNT PARCEL, 1401
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REMARKS
PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION nr-w-u
VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE
LAZING %
LOT SLOPE %
Building Permit
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PLAN CHECK NO:
VESTED DATE
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Mechanical
THIS PERMFT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
2
3 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180DAYS
IL PERMIT UMrr 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT; ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
IALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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Recording Fee
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I HEREBY 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 OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application Is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Offlclal or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknowledged In space provided.
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CITY OF EDMONDS
USE 13EIRMIT
ZONE NUMBER
JOB SUITE/APT#
ADDRESS
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CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
PLAT NAME/SUBDIVISION Nb.
LOT NO.
LID NO.
LID FEE $
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MAILING ADDRESS
72V 7
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION— FT
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TESCP APPFDV&d
RW Permit Required
Street Use Parrnh Req'd
InspecWn Required
Sidewalk Required
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CITY ZIP
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TELEPHONE
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NAME
METER SIZE
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REMARKS
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STATE LICENSE NUMBER EXPIRATION DATE
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PARKING
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PLANNING REVIEWED BY DATE
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REMARKS
DEMOLISH TANK OTHER
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CARPORT ROCKERY FIRE ALARM
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REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG'D
VALUAnON
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT'SLOPE %
Building Permit
City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
O.L, rx) 4
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERUrr COVERS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONIX AM CONSTRUCTION ON THE PUBILIC
Grading
a U
DOMAIN JCURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) W61LL RED IRE
I_ SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: ISODAYS
IL PERMIT UMrP I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINKPERMIT FOR MORI� INFPRMATION
.-APPLICANT, ON B"LF OF HIS OR HER SPOUSE i HEIRS, ASSIGNS AND SUCCESORS
;�iDMOLD'HARMLESS THE CITY
Fire Review
Plan Chk. Deposit
IN INTEREST AGREES TO INDEMNIFY. DEFEND OF'
EDMONDS, '�ZINGTON, gS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
OR INDIRECTLY
Fire Inspection
Receipt #
ALL CLAIMS FOR OAMAPdS V WHATEVER NATURE, ARISINP PIRECTLY
FROM THE ISSUANCE OF T141S PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
'DEEMED TO MO DIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapeinsp.
Total Amt. Due
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee
Rece #
Ipt
I HEREBY 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 OWNEFL I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application Is nri a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
Building Official or hlsfher Doputy� and Fees are paid, and
FOR INSPECTION receipt Is acknowledged In space provided.
WORKMEN'S COMPENSATIO��URANCE AND RCW 18.27.
.— I
OAFFIS RE DATE
- -
S19"RE (OWN PEN'� DATE SIGNED
ORX
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6SIGAT
. 11 , ,
771 -0220
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by DATIt
RELE(SEP
ATTEWrION
M 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL -FILE - YELLOW. INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER - GOLD -ASSESSOR
04102 PRESS HARD -YOU ARE MAKING 5 COPIES_' GREEN -ACCOUNTING
INNER,
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