20020751.pdfM
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CITY OF EDMONDS
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CONSTRUCTION PERMIT APPLICATION
JOB SUITEIATf.
ADDRESS
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PLAT NAME/SUBDIVISION NQ
LOT NO,
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CITY ZIP ITILEPHONE
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NAME
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NO, OF FIXTURES
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ADDRESS
REMAR"' se
WNERI.ONJ RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY
NAME
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FIRE REVIEWED BY DATE as
ADDRESS
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STATE LICENSONUMBER EXPIRATION DATE
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a�OLF300,:>_2.0 00
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LOT AREA P No A JEW 5 D E
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REPAIR [3 GRADING E] F
Fri
REMARKS
DEMOLISH TANK OTHER
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se CARPORT FICICKERY REAIWM
(TYPE O=INESS OR ACTIVITY) EXP N:
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PROGRESS INSPECTIONS
PER UBC IGO/FINAL INSPECTION REG'D
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Description
FEE
Description
FEE
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PI I ChDC'
State Surcharge
HEAT SOURCE --"I- LOT BILGIS I
Building Permit
City Surch.rg.
PLAN CHECK 1 VESTED DATE
Plumbing
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Mechanical
THIS PERMIT AUTHORIZES ONLYTHE ORK NOTED. THIS PERMIT COVERS WORKTO
t 8 DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE Pusuc
2 DOMAIN (CURES. SIDEWALKS, DRIVEWAYS, MARQUEES. UC.) WILL REQUIRE
— SEPARATE PERMISSION.
PER ITAPPUCATION: 180DAYS
PERMIT LIND R I YEAR - PROVIDED WORK IS STARTED WITHIN 100DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
NT. ON IIIIAIF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
INC
IN INTEREST, AGREES TO GEMNIFY, DEFEND AND HOLD HARMLE 3 THE CITY OF
EDMONDS' WASHINGTON. ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATIME, ARISING DIRECTLY OR INDIRECTLY
FROM TH ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINA GE
C NOR LIMIT IN ANY WAY THE ITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Grading
Engr. Revim
Engr. Inspection
Fire REVIEW
Fire inspection
Land.cape Insp.
Recording Fee
7la7.-,,L.ePoSh
Receipt #
Total Amt. Due
Receipt #
I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
T E OWNEIL I AGREE TO COMPLY WITH CITY AND STATE LAW REGULATING CONSTRUC
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EM LOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON REILAHNQ TO
WORKMENS OMPENSATION INSURANCE AND RCW H1,27.
SIG �REVER ZAN:�6��,
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APPLICATION APPROVAL
CALL This applienn-e Is ne. P-1-11i sipa.d by Unt
B.11ting 01116.1., Metes, DeTedy; and Fees ate paid. and
FOR INSPECTION IP11-sk—ledgedinsp .. 011d0d.
OFF DATE
(425)
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771-0220 'bATE
ATTENTION EXT 1333
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. USC SECTION 109
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IT IS DUE TO THE QUALITY OF THE DOCUMENT.
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