20030205.pdfa
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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STATE LICENSE NUMBER EXPIRATION Di
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PROPERTY TAX ACCOUNT PARCEL NO
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ADDITION
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NUMBER
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PERMIT
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PLAT NAME/SUBDIVISION NO.
LOT NO.
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LID FEE $
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BIN P@ t Required
EXISTING PROPOSED
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REQUIRED DEDICATION Fr
Sidewalk Required
undevourw
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METER SIZE
LINE SIZE
NO. OF FIXTURES
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YE E NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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FIRE REVIEWED BY DATE W
VARIANCE OR CU
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SEPA REVIEW
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LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (Fr.)
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FRONT URSIDE REAR
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SPECIAL INSPECTION I-A—REA
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LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC.100/FINAL IMSPECTION REO'D
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V Descirfoon FEE Description FEE
Plan Check State Surcharge
EAT SOURCE (:GLAZING % C
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CT-T S Building Permit Ity Surcharge
PLAN CHIECK NO: VESTED DATE
.01) VP1
Plumbing
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBUC
DOLMN SIDEWALKS,
Grading
(CURBS, DRIVEWAYS, uARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMITAPPILICATION:
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180 DAYS
PERMIT LIMIT! I YEAR - PROVIDED WORK 15 STARTED WITHIN ISO DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMIATIOH
Engr. Inspection
'APPLICAK ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY. DEFE14D AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Fire Inspection
Receipt #
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
Landscapelnsp.
Total Amt. Dur.
NOR LIMIT IN ANY WAY THE CIr1rS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
Recording Fee
Receipt #
I
I HEREBY 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 APPROVAL
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 EMPLOYED
CALL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
IN VIOL_A.T,�THE LA_4GR-CMX--4DF THE STATE OF WASHINGTON RELATING TO
WO=NS AND RCW 18,27.
FOR INSPECTION receipt Is acknowledged In space provided.
DATE S NED
IA105
OF S IGNATU DATE
77-02
1 20
RELEASED f DATE
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
ORIGINAL - FILEO - YELLOW - INSPECTOR
PINK - OWNER - GOLD - ASSESSOR
04/02 PRESS HARD -YOU ARE
MAKING 5 COPIES GREEN - ACCOUNTING
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