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Description
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THIS PERMIT AUTHORIZES ONLY THE WORk NOTED. THIS PERMIT coviEns WORK TO
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Grading
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PFRMrTAPPLICATION: 1100 DAYS
PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 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
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IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
AQ9_76
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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Total Amt. Due
9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
21 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION,*
Recording Fee
Receipt #
I HEREBY 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 applicaflon Is not a permit until signed 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 official or his/her Deputy: and Foos are paid, and
receipt Is acknowledged In space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
ATURE DATE
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SIG147AT�/
DATE SIGNED
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771-0220
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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-
ORIGINAL - FILE'- YELLOW INSP E"CTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
GREEN - ACCOUNTING
FINAL PROJECT APPROVAL FORM
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RE -INSPECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
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DATE RE,:EAD
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CITY OF EDMONDS
CONSTRUCtION PERMIT APPLICATION
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STATE LICENSE NUMBER
3ROPERTYTAX ACCOUNT PARCEL NO.
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DEMOLISH
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NUMBER
NUMBER OF
OF
DWELLING
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STORIES
UNITS
DESCRIBE WORK TO BE DONE on
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PLUMBING I MECH
COMPLIANCEOR
CHANGE OF USE
SIGN
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FIRE SPRINKLER
FIRE ALARM
CRMCAL LA./
AREAS
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PERMIT EXPIRES
USE PERMIT
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NUMBER
JOB
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PLAT NAME/SUBDIVISION NO.
LOT NO.
CID NO.
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LI'D FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL,?ITgET MAP
TESCP APPrOvGd
RW Permit Required
street use Permit no"
EXISTING __.wczt�__PROPOSE@
inspection Required
4
Sidewalk Required
REQUIRED DEDICATION— FT
Underuround
Whing required 13
METER
LINE �IA
NO. OF FIXTURES
PRV REQUIRED
YES 13 NO 13 0z
REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE us
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ALLOWED PROPOSED
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REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT L/R SIDE REAR
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PARKING
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Description
FEE
Description
FEE
Aemips,
Plan C heck
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit
City Surchar go
PLAN CHECK VESTED DATE
Plumbing
/A&10;rz
Mechanical
Tms PFRmrr AuTHoR=s ONLY THE WOIAC NOM. THIS P VE S WORK TO
BE DOME ON PRrvATE PROPERTY o" Amy coN= PU j
N3 SIDEWALKS, ORIVEWAV% MARQUEES, ETC.) RE09FICE
Grading
DOMAIN (CURBS,
SEPARATEPEWASSION.
Engr. Review
PERMIT APPLicAmoitim DAYS
PERMIT ILIMM I YEAR -PROVIDED WORK 13 IIII[ARTED WITHIN ISODAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MM INFORMATION
-APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. MRS, ASSIGNS AND SUCCESORS
Fire FeVIeW
Plan Chk. Deposit
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON. ITS OFFICIALS. EMPLOVEES, AND AGENTS FROM ANY AND
Fire inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATUR124 ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMrr. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscape Insp.
Total Amt. Due
DEEMED TO MODIFY; WAIVE OR REDUCE ANY REQUIMMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFOFICE ANY ORDINANCE PROVISION.'
Recording Fee
Receipt #
I HERE13Y ACKNOWLEDGE THAT I HAVE READ THIS APhUTION; THAT THE� INFORMATION
GIVEN 18 CORRECT; AND THAT I AM THE OWNER, 09 NE DULY AUTHORIZED AGENT OF
MN ...... MO —A
APPUCATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
TION; AND IN DOING THE WORK AUTHORIZED THERM No PERSON WILL 13E EMPLOYED'
CALQ
This application Is not a permit until signed by the
Building Official or hill/tier Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE Or WASHINGTON RELATING TO
FOR INSPEcinON
reCeIpj Is ackn2Vedged in space provided.
WORKMENS COMPENSATION INSURANCE AND RCW Iz27.
I IALS IGNATURE DATE
SIG R R DATE SIGNED
(42
MOW 7�
6 - 30 '03
771-022 0
, I �
' DAT
CV7 -1 J.%
R91. S D Bt—
All 1 1114 IIIIIJIM 113
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS.BEEN MADE AND APPROVAL OR A CERTIFI- OFIIGINAL-�Ia- YELLOW- INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER .- GOLD -ASSESSOR
04/02 U ARE MAKING 5 COPIES GREEN ACCOUNTING
PRESS HARD -YO
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