20030616.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
�ME/NAME OF BUSINESS
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NUMBER ,, EXPIRIATI'N
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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NO. OF FIXTURES
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EMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE_
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ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
VARIANCE OR CU SHORELINEORADB# INSPECTION BOND
REO'D POSTED
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ALLOWED PROPOSED
FRONT SIDE REAR
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
PARKING
LOT AREA
PLANNING REVIEWED By DATE
06
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REMARKS
DEMOLISH
TANK
OTHER
GARAGE
RETAININGWALL
FIRE SPRINKLER
CARPORT
ROCKERY
FIRE ALARM
(TYPE OF USE, BUSINESS
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NUMBER
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NUMBER OF
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CRITICAL
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SPECIAL INSPECTION
OCCUPANT
STORIES
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LOAD
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REMARKS
PROGRESS INSPECTIONS PER USC 108/FINAL INSPECTION REGfD
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VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOLMN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPILICATION: 180 DAYS
PERMIT ILIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
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 OF WHATEVER NATURE, 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
NOR LIMIT IN ANY WAY THE C17YS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRE" 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-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF.1HE LABiNkCODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEITS4!�I:tRANCE AND RCW 18.27.
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SIAINAMIMFE13WINIERob �k;ENW, / A DATE SIGUED 7
$
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
L5
City Surcharge
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapoinsp.
Total Amt. Due
Recording Fee
Receipt #
ZZ5-73-
CALL
FOR INSPECTION
IA13
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771-0220
APPLICATION APPROVAL
This application Is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt Is aCknovAedged In space provided.
OFFICIAL�-SI�G �ATURE DAT5
T
RELEASED BY DATE
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ATTENTION Off 1 3
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -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
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TO:
DATE:
MEMO TO: PERMIT COORDINATOR,
BUILDING DIVISION
FIRE DEPARTMENT DATE—aS�--�—
FROM: .......
ENGINEERING DIVISION DATE-----�
D
-YLANNING DIVISION ATEL . . .......
s ADDRES S 'LJ
DATEIN SPECTED
PERMIT #
*n0N OF TO BE INSPECTED
fieldinspection, was c6 diuietted to
eurmine flnal compu th Sel f
ance with soproved plans. jejell,
to e,
"d6ho M are,� no objec,
ious from ithe, above signed Departme nt:
FORMANCE B O.NDa the granting.
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..2�-_GRANT FINAL
PROJE CT APPROVAL
RAM, PROVAL W.714
PROJECT
CONDITIONS NOTED
of' O"YnON S given,to
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FA"D.ENALINSpECTION OWSTANDING
ISSUES
even to owner/contractor by inWector
COPY CORRECMON NO
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RE I -INSPECTED OUTSTANDING [SSUES _ GRANT ENAL PROJECT AYFKU Y Ai
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