20020833.pdfPERMITEXPIRES 4/-4"
PERMIT
ZONE 12�51
CITY OF EDMONDS
IN UMBEFt4
CONSTRUCTION PERMIT APPLICATION JOB SUITEJAPT#
ADDRESS
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MAIL NG ADDRESS LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP 'Gicy
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CITY EXISTING
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SIZE PFW REQUIRED
NAME METER SIZE I LINE I NO, 01 FIXTURES
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ADDRESS REMARKS
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NAME
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ENGINEERING REVIEWrED
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FIRE REVIEW. .1
DATE
CITY
TELI HONE
STATE LICENSE NUMBER
1XII—ION DATE CIIECZ
VA"ANC'O'CU I
SHORILIMEORAIIII I INSPECTION BONO
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aROPERTY TAX ACCOUNT MRCEL
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SIGN AREA HEIGHT
I ALLOW.. , PROPOSES ALLOWED PROPOSES
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LOT COVERAGE
REQUIRE KS (FT. ROPOSED SETBACKS (FT)
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FRONT SIDI REAR FRONT iJBSIDE REAR
ADDITION
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(TYPE OF USE,
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CHECKEDBY JTYPE��
NUMBER OF
CRITICAL
DWELLING
AREAS
SPECIAL INSPECTION JAREA
UNITS
NUMBE R
REQUIRED n LOAD
DESCRIBE WORK TO BE DONE
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Description
Description FEE
Plan Check
State Surcharge
SWING % Or 'lop,
Building Permit
City Surcharge 5—
PLAN CHECK NO:
lumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE ORK NOTED. THIS PERMIT COVERS WORKTO
tz HE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
:1 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
X
It SEPARATE PERMISSION.
Engr. Review
PERMITAPPUCATION: ISO DAYS
PERMITLIM .11 YEAR -PROVIDED WORK IS STARTED WITHIN IODDAYS I
Engr. VInspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ESOA
-APPLI NT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND S C -
Fire Review
PlanChk.Deposit
I. INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THUEC
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS 1RO1,N ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR DIRECTLY
Fire Inspection
Receipt N
FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALT NOT BE
DEEMED TO MODIFY, WAIVE OR RED CE ANY REQUIREMENT OF ANY CITY ORDINANC
Landscapainsp.
Total Amt. D..
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee
Receipt N ZM2
I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER. 08 THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUG.
CALL
hjppjI.,dj is car. pence infil.19ned by in.
7ION; AND N DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE ITAOOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
uLd Ing Official 11 his1he, Dp,ay: and Fees are paid. and
n,cIps 1, Icklowl0dord 11 pace proWded.
WORKMEN's COMPENSATION INSURANCE AND RCW 18.27,
- - - - - I
SIGN DATE
III NATURE( WNE OR AGENT)
(425)
71S
/
771-0220
-OHELEASEO'BY
DATF/
A NTION
�O4/OCCUPY
EXT 1333
IT IS UNLAWFUL TO`� A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORGINAL-FILE YELLOW -INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN ACCOUNTING
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FRAMING ........................
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
Wall Insulation
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS
FINAL APPROVAL FOR ID
OCCUPANCY ..............
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