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Building Permit
City Surcharge
PLAN CHECK NO- VESTED DATE
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Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
2 DOLMN (cunes, sIoEwALKs, DRIVEWAYS, MARQUEES. ETC.) W1LL REQUIRE
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SEPARATE PERMISSION.
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5 PERMIT APPLICATION: 180DAYS
IL PERMIT UMrP I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR PADRE INFORMATION
MIN
-APPLICAK 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
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE C"S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee
Receipt#
I HERE13Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORREC T, 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
Building
FOR INSPECTION
official at hisfher Deputy: and Fees are paid, and
receipt Is acknowledged In space provided.
WORKMENS COMP SUVO�NCE AND RCW 18.27.
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SED a VATE
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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-INSACTOR
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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DATE RECEIVED
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PLAT NAME/31,19DIVISION NO. LOT NO. LID NO.
MAILING ADDRESS
LID FEE S
4
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Peffnit Required
Street Use Perm4 Roq'd
CITY '% ZIP TELEPHONE
EXISTING PROPqSED Irapection Required
Sidew0k Required
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1 40
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REQUIRED DEDICATION— Fr Wiring required 13
NAME
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
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ADDRESS
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAQE
CITY ZIP TELEPHONE
NAME CBLN
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ENGINEERING REVIEWED BY DATE
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VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
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113YES
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ONO $
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PROPERTY L NO.
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
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NEW RESIDEN-nAL MECH
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.)
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ADDITION rje COMMERCIAL 0
CHANGE OF USE
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NUMBER OF CRITICAL
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OF DWELLING V\,,:rAREAS
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UNITS NUMBER
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DESCRIBE WORK TO 61 RDNE
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REMARKS
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Description
FEE
DescriptIon
FEE
Plan dhock
State Surchargq
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
01 _.:2�
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DOME 0 ROPERTY ONLX AW CONSTRUCTION ON THE PUBLIC
N PRIVATE P
Grading
:03 DOUNN (CURBS, SIDEWALKS, ORMVAYS, MARQUEES, ETC-) Wwu. REQUIRE
SEPARATE PERMISSION.
Engr. Review
PER ITAPPLICATION: 180DAYS
PF RMrr UMM I YEAR -PROVIDED WORK IS STARTED WITHIN 180DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
We Review Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE C17Y 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
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapelnsp. Total Amt. Due
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee Receipt #
I HERE13Y 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 aWlIcation Is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building OMcW or hb/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION receipt Is acknowledged In space provided.
WORKMENS COUPE SUfANC No RCW 18.27.
C SIG PPAQ-DATF
8? RE ER ro DATE SIG D
I'm rw�
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QfATE
..771-0220 RFI�M%SED BY
ATTENTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR ST RUCTURE UNTIL,
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLON - INSI(EECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR
GREEN - ACCOUM ING
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES