20030237A.pdf4
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PERMIT EXPIRES
USE PERMIT
CITY OF MONDS ZONE NUMBER
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS 6C
OWNER NAME/NAME OF BUSINESS
'L PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
MAILING ADDRESS LID FEE $
TESCIR Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Per It Requited
L street Umse Permit Roqd
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EXISTING — PROPOSED Inspectlo Required
CITY ZIP TELEPHONE -Z SIdirwatit'Req Ited
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if :Z REQUIRED DEDICATION— FT Witing required
NAME METER SIZE LINE SIZE OF FIXTURES PRV REQUIRED
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ADDRESS REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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CITY ZIP ONE
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(TYPE OF USE, BU EBB OR ACTIVrM EXP N:
— CHECKED BY OF CONSTRUCTION CODE OCCUPANT
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NUMBER NUMBER OF CRITICA
OF DWELLING AREAS SPECIAL INSPECTION OCCUPANT
LOAD
JAREA
—STORIES UNITS NUMBER REQUIRED
DESCRIBE WORK TO BE DONE C�d I &Vn
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
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VALUATION
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Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit 40 City Surcharge
PLAN CHECK N VESTED DATE Plumbing
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THIS PERMIT AUTHORIMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
h BE DONE ON PRIVATE PROPERTY ONLY. MY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 1130 DAYS
IL PERMIT LIMM 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICAK ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk, Deposit
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapelnsp. Total Amt. Due
DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 Non LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
Receipt # J'tcr Z'
Recording Fee 1A
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION ION APPR
APPLICAT
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- Irih 1.5,1not a permit unfit signed by the
CALL
B.,9VGII0n
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED , d , oto 111 cr hi her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION rec I is apitnowledged In space providoA j
WORKMEN.S COM SATION INSURANCE AND RCW 18.27. 11 SIGN URE
DAT
SIGNATU (OWNEAPFIA AT SIGNED '1-4125)
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771-0220 D BY DA
ATTENTION Off 1333
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORtGINAL - 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