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CONSTRUCTION PERMIT APPLICATION
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SEPA REVIEW SIGN AREh I HEIGHT
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LOT COVERAGE REQUIRED SETBACKS ii PROPOEED SETBACKS (FT)
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(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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REMARKS
EIIOGREq_�.INSPECTIONS PER UBC 11081FINAL INSPECTION It
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VALUATION $
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Plan Check
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PLAN CHECK NC VES
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THIS PERMIT AUTHORIZER ONLY WE WORK NOTED. THIS PERMIT COVERS WORK To—
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It BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
Recording Fee
:I DOMAIN JCURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REOUIRE
SEPARATEPERMISSION.
Engr, Review
any
City Surcharge
HE M`TAPPUCATION` INDAYS
Y"A PROVIDED IS STARTED
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00
'5�
PERMIT LIMIT I - W RK WITHIN 10 DAYS
BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. inspection
. SUc
Surcharge
_SEE
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS ASSIGNS AND SUC ESORS
Traffic Mitigation
Plan Chk Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND H& 0 HARMLESS THE
AND
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Receipt At
EDMONDSWASHINGTON, IT OFFICIALS. EMPLOYEES. AGENTS FROM ANYAND
ALI. CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY 00 INDIRECTLY
Fire Review
FROM THE ISSUANCE OF THIS PERIAM ISSUANCE OF THIS PERMIT SHALI NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREME14T OF ANY CITY OROINA CE
91
Fire inspection
Total Amount Due
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
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Receipt #
I HERE ACKNOWLEDGE Tivar I HAVE READ THIS APPLICATION;: HAT 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 appliamid, 1, not a permit date signed by the
TION; AND IN DOING Tf E WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
Harding
FOR INSPECTION
ai.h.�,fDotndy: and Fees are paid. and
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WORKMENS COMPENSAR BE AND ROW 18,27.
rfl'��ATURI�5y DATE SIGNED
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RELEASED
BY
DATE
ATTENTIOf
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
07R,1(31-L 'E YELLOW
/WNER
INSPI�GTO
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
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