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7 DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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PLAT NAME/SUBDIVISION NO. 777O.'a'se
LID NO.
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
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EXISTING — PROPOSED
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Description
FEE Description FEE
Plan Check
State Surcharge
HEAT SOUR7E GLAZIN13 11 LOT SLOPE %
Building Permit
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City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMrrAPPUCATION: 1160DAYS
PERMIT UMrT11 YEAR -PROVIDED WORK IS STARTED WITHIN 1160DAYS
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
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
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Total Amt. Due
I DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Recording Fee
Receipt # 7
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APP ICATION APPROVAI.,.
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH C17Y AND STATE LAWS REGULATING CONSTRUC-
CALL
This application Is not a permit until signed by the
TION; AND IN DOIN ORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official or his/her Deputy: and Foos are paid. and
IN VIOLATIONAW,;TH7E0, OR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt is acknowledged In space Provided.
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WFUIAW SIGY� RE DATE
SI UR R DATE SI NED
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EXT 1333
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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NUMBER
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LOAD
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DESCRIBE WORK TO BE DONE
REMARKS
P ROGRESS INSPECTIONS PER UBC I 08/FINAL INSPECTION REGID
$
Description
FEE
Description
FEE
V.
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit
A -
City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
'THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLX AM CONSTRUCTION ON THE PUBLIC
Grading
23 DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
t:
Engr. Review
5. PFIRMITAPPLICATIOW IGO DAYS
06 PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'j"APPLICANT, ON BEHALF OF HIS OR HER SPOUSE HEIRP, ASSIGNS AND SUCCESORS
IIN IkTEREST, AGREES TO INDEMNIFY, DEFEND i�D HOLE) HARMLESS THE CITY OF
Fire Review
Plan Chk. Deposit
)ED YONDS, WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
�ALU CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISIND DIRECTLY OR INDIRECTLY
�FR OM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
�VEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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Total Amt. Due
PW LIMIT IN ANY WAY THE CITTS ABILITY TO ENFORCE A14Y ORDINANCE PROVISION.'
NIXON
Recording Fee
Receipt #
I HME13Y 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
THEOWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
This appikatIon Is not a permit until signed by the
T104; AND q Doloq,�RK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
01 -_ , _
IN VIOLATIO THE OR CODE OF THE STATE OF WASHINGTON RELATING TO
euuftg Official or his/her Deputy: and Foes are paid. and
FOR INSPECTION /I � receipt Is acknowledged in space provided.
WORKM���TIO'N RANCE AND RMY 18.27.
t* SIGNAIJU RE DATE
BIG R R OR DAIE 81 NED
(4�25
Z163
7M��l 7
771- -0220
RELEASE6 tY
AT Wf 1659
EXT 1333
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