20030403.pdfDATE RECEIVED PERMIT EXPIRES
USE PERMIT
CITY OF EDMONDS ZONE Lag NUMBER C&1�5
JOB SUITE/APT#
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OWNER NAMENAME OF BUSINESS
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STATE LICENSE NUMBER
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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EXISTING — PROPOSED
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Description FEE Description FEE
P13Nheck State Surcharge
HEAT SOURCE GLAZING % LOT..8LOPE %
Permit City Surcharge —6-02-
PLAN CHECK NO: VESTEDDATE/F Plumbing
03— 1 Ls Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONIX ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180 DAYS
PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN ISO DAYS Engr. Inspection
SEE BACK 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 INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection ge::�l Receipt #
IALL CLAIMS FOR DAMAGES OF WHATEVER MATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapeinsp. Total Amt. Due
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
— , Recording ee Receipt #
I HEREBY ACKNOWLEDGIS THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION I I
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- CALL This application Is not a permit unJI signed by the
TION: AND IN DOING THE WO ORIZED HEREBY. NO PERSON WILL BE EMPLOYED Building OMcial or his/her Deputy: and Fees we paid, and
WF S FOR INSPECTION
IN V10jfTION OF THE JA _R1,7CE lOF THEr TATE OF WASHINGTON RELATING TO receipt Is acknowledged In space provided.
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IT IS UNi(AWUL TCr USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 14'41z&iy1&4'"1U
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE - YELLOW - IN
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER - GOLD - ASE,
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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DATE RECEIVED
PERMIT EXPIRES
USE E P PERMIT
CITY OF EDMONDS ZON NUMBER
JOB SUITEIAPT#
CONSTRUCTION PERMIT APPLICATION ADDRESS 1A /) I)
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NAME
METER SIZE
LINE SIZE
NO. OF
FIXTURES
PRV REQUIRED
YES 13 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FO�,4SION CONTROL/DRAINAGE
ADDRESS
CITY ZIP
ELEPHONE
NAME
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REMARKS
PROGRESS INSPECTIONS PER US C
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FEE
Description
FEE
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Mechanical
TMS PERMIT AUTNIORMES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE IDM ON PRIVATE PROPERTY ONLY. ANV CONSTRUCTION ON THE PUBLIC
Grading
D0I1lUUN,(CURB8, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
612PARATEPERMISSION.
Engn.Review
PERWAPPLI(*TIOW� IGO DAYS
PERMIT uum I MR - PROVIDED WORK IS STAR= WITHIN 190 DAYS
Engr. Inspection
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SEE BACK OF PINK PERMIT FOR,"RE INN)RIIIIIATION..
APPLICANT, ON BEHALF 0 . F HIS OR HER SPOUSE, H EIRS, ASSIGNS AND SUCCESORS
ew
Plan.Chk. Deposit
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
DS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
!70�0.
Receipt #
ALL CLAIMS OR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapeinsp.
- —
Total Amt. Clue
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ncciAcn i ) uf%t)lcv WAIVE OR REDUCE ANY REQUIREME OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITTS ABILITY TO ENFORCE ANY ORDINANCE PROVISION." Receipt #
Recording Fee I I
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION APPLICATION APPROVAL
GIVE IS CORRECII AND THAT I AM THE OWNER.'OR THE DULY AUTHORIZED MENT OF
THE MER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application Is not a permit until signed by the
TION; AND IN DOING THE THEREBY. NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy: and Fees are paid, and
ORIZED FOR INSPECTION receipt Is acknowledged In space provided.
IN VICATION OF THE VnCUO EIOF THE STATE OF WASHINGTON RELATING TO
WORPINJI)COMPSNffn U CE AND RCW 18.2 E
OFFICIA, �NAT &U T
DATE SIGNED (A*
BIG GENT) 1,425)
03 DA
771-0220
ATTEN Off 1333
IT IS LIN L T USE OR OCCU4 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- PINK - OWNER GOLD - ASSESSOR
GREEN - ACCOUNTING
04/02 PRESS HARD YOU ARE MAKING 5 COPIES