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Description
FBuildlng
FEE Description FEE
oPlan Check
State Surcharge
H 4TSOU.RCE GLAZING %
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Permit
CitySurcharge
PL_ N CH I( NO- VESTED DATE
Plumbing
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBILIC
DOMAIN (CURBS. SIDE
-WALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
Grading
SEPARATE PERMISSION.
Engr. Review
PERMIT APPUCATION:
IL
160DAYS
PERMIT UMIr I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK
Engr. Inspection
OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposi&
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES
Fire Inspection
Receipt #
OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT HE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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Total Amt. Due
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, NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
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Recording Fee
Receipt #
I HEnEBY 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
APPLICATION APP5ROVALL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLJOYED
CALL
This OPPlication Is not a permit until signed by the
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMP"ATION
FOR INSPECTION
Building Official or his/her Deputy: and Fees are paid and
f0c(lipt Is acknowledged In space provided.
INSURAtAE AND RCW 18.27.
SIGNATURE (OWN IATE GNED
(425)
OF ICIA SIGNAT DATE
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771-0220
Off 1333
V*SED BY DATE -
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. UBC SECTION 109
ORIGINAL - FILE YELLOW - INSPECTOR
09/03
PINK -OWNER GOLD -ASSESSOR
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DATE RECEIVE6
FPERMIT EXPIRES
C1W OF EDMONDS
USE PERMIT
ZONE
NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB
ADDRESS
SL
N�AE AM E OF BONESS
PNER
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PLAT NAME/SUBDIVISION NO. LOT NO.
LID NO.
MAILING ADDRESS
LID FEE $
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CITY ZIP TELEPHONE
EXISTING — PROPOSED
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Sidowatic Required 13
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REQUIRED DEDICATION— FT
Undergmund
wiring required [3
NAME
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ADDRESS
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INSPECTION BOND
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OR
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0 ADDITION
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COMPLIANCE
CHANGE OF USE
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REMODEL
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FT) REMARKS
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GROUP
NUMBER
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CRITICAL
AREAS
SPECIAL INSPECTION
JAREA
OCCUPANT
STORIES
UNITS
NUMBER
REQUIRED [:] YES
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION REO'D
2
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Description
FEE
Description
FEE
f(I
'CaL ifn,04 efic- 60), _jg
Plan Check
State Surcharge
HEAT SOURCE GLAZING
Ing Permit
City Surcharge
PLAN CHIMIK NO: VESTED DATE
Plumbing
Base Fee 0
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES. ETC.) WILL REOUIRE
SEPARATE PERMISSION.
Engr. Review
PERMITAPPLICATION: 180DAYS
PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE 13ACK 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 INDEMNIFV; DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALI. CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT $HALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapoinsp.
Total Amt. Due
NOR LIMIT IN ANY WAY THE CITVS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
—
Recording Fee
Receipt #
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 Official or his/her Deputy: and Foes are paid. and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
'FOR INSPECTION receipt Is acknowledged In space provided.
WORKMENS�ffN INSUR0�E AND RCW 18,27.
DATE
OF SIGNAT40
SIGNATURE (OWN I DATE GNED pm--ab)
771-0220 BED BY DATE
-ATT&MON f Off 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- OR�GINAL-FILE YELLOW- INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PNK-OWNER GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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