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DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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LID FEE $
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW Permit Required
Street Use Permit Req'd
EXISTING — PROPOSED
inspection Required
Sidewalk Required
REQUIRED DEDICATION— FT
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Wiring required 13
METER SIZE
NO. OF FIXTURES
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REMARKS
OWNERJCONTRAcTOR RESPONSIBLE FOR EROSION CONTROLJDRAINAGE
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Description FEE Description FEE
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THIS PERurr AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DOME ON PRIVATE PROPERTY ONLX AM CONSTRUCTION ON THE PUBLIC
Grading
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SEPARATE PERMISSION-
Engr. Review
PERUrTAPPLICATION: 180 DAYS
PERMIT umm I YEAR - PROVIDED WORK 19 STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Fire Review Plan Chk. Deposit
'APPLICAK ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
CITY OF
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE
OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection Receipt N
EDMONDS, WASHINGTON. ITS
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
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DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
WAY THE CnYS ABILITY TO ENFOR CE ANY ORDINANCE PROVISION.*
Receipt #
NOR LIMIT IN ANY
Recording Fee
THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL/
I HEREBY ACK14OWLEDGE
GIVEN IS CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
This application Is not a permit until signed by the
CALL Building Official or his/her Deputy: and Fees are paid, and
THE OWNER. I AGREE To
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
receipt is acknowicidged In space provided.
FOR INSPECTION
WORKMEN'S COMPENSATION INSURANCE AND RCW 18,27.
OFFICIALS SIGNATURE DATE
- DATE
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SIGITUR
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771-0 DATE
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EXT 1333
ENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL IF
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE YELLOW - INSPfCTOR
A FINAL
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SE CTION 109
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OWNER NAMEINAME OF BUSINESS
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Street use Permit RWd
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REQUIRED DEDICATION— FT WWgrequkad 13
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NAAEt,4 METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES 13 NO E3
ADDRESS REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDFLAINAGE
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PARKING LOT AREA T P4NNING REVIEWED BY D E
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REPAIR CYOS ( x FT) REMARKS
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CHECKED BY TYPA OF CONSTRUCTION CODE OCCUPANT
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NUMBER' BER OF CRITICAL4�
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DESCRIBE WORK TO BE DONE 1 . A REMARKS
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Descriotion FEE Description FEE
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Building Permit
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PLAN CHECK NO:
VESTED DATE Plumbing
Mechanical
THIS PERMIT AUTHORIZEG ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBILIC
Grading
2 DOMAIN (CUM, SIDEWALKS, ORNEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSIOtL
Engr. Review
PERIATTAPPILICATION: IDODAYS
PERMIT UMM I YEAR - PROVIDED WORK 19 STARTED W1ITH1IN 160 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
Fire Review
Plan Chk. Deposit
IN INTEREST,
EDMONDS, WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
I
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE or THIS PERMIT SHALL NOT BE
Landscapoinsp.
Total Amt. Due
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DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CTTVS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
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Recording Fee
Receipt #
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I HIEREBY 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 applicaUon Is not a permit until signod by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Building Metal or his/hor Deputy: and roes tire paid, and
receipt Is acknowledged In space provided.
WORKMENS COMPENSATION INSURANCE AND RCW 18.27.
OFFICIALS SIGNATURE DATE
SIGN
%TURE,AOW�E�RW
AX
DATE SIPNED
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771-0220
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ATTENTION Jr
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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-
ORIGINAL -FILE - YELLOW- INSI74CTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK-OMER - GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
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