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PERMIT EXPIR
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'C'S PERMIT
CITY OF EDMONDS NUMBER260 Z - c,_7 7 7
CONSTRUCTION PERMIT APPLICATION 'LaDRESS SUITCIAPT�
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PLAT NAME/SUBDIVISION NO LOT NO, L
L�D NO.
MAIL NO ADDRESS a FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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CITY ZIP EXIST NO — PROPOSED
TELEPHONE 0
REOUIREDDEGICATIOIN— FT
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STATE LICENSE NUMBER EXPIRATION DATE �OY . OYRE POST 0
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AL SIDE REAR FRONT US SIDE REAR 0
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CHANGE OF USE __7ATE
PARKING LOT AREA PLANNING REVIEWED By
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REPAIR GRADING CYOS F NCE
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NUMBER ---
OF DWELLINO AREAS PEC L INSPECTOR ASEAZ PANT
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FOL;JA
o STORIES NUMBER RED
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
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VALUATION
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PLAN CHECK FEE
REA—TSOURCE /I I rLOING % LOT SLOPE I
ADATE
BUILDING
PLAN CHEC���
PLUMBING
JVBSTED
MECHANICAL
THIS PERMIT AUTHO IZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
REOU
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL IRE
GRADINGIFILL
SEPARATE PERMISSION.
—
GT3TA SURCHARGE
PERMIT APPLICATION: IGO DAYS
PERMIT LIMIT�l 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
END, INSPECTION FEE
IN NTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAP NO
2 EDMONDS, WASHINGTON, ITSOFFICiALS,EMPLOYEES,AND AGENTS FROM ANY AND
`G IN
ALLCLAIMSFOT DAMAGES OFWHATEVER NATURE, ARISING DIRECTLY OR DRECTLY
INSPECTION FEE
PT
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
2 DEEMED TO MODIFY, WAIVE OR REOU E ANY REQUIREMENTOF ANY CITY ORDINANCE
PLAN CHECK DEPOSIT
11
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
R CEIPT ,
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TOTAL AMOUNT DUE
/
IS y,�q 9
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I HEREBY ACKNOW EDGE 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
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TION, AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LAB I OD F THE STATE OF WASHINGTON RELATING TO
_
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FOR INSPECTION 1-Ft 11 alk—ld9ld 1011. pl-dod,
WOAKMEN'S CG,PENSATI NS RANCE AND ACW 18 27.
OFF�CI_17NA TURE DATE
51-0—MATUR, IOWN OJAI DATE SIGNED,
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(4' 25)
,
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2L m/ M(,
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771-0220
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—RELEASED
AE R
DAT`E
10 N
EXT/333
IT IS UNLAWFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
1
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL FILE - YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109
FAX
PINK - OWNER - GOLD � ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall...........................
Pier/Porch ................
wall
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ................
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