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DATE RECEIVED ERMIT EXPIRES
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USE PERMIT
CITY OF EDMONDS ZONE ez!5 NUMBER -�Uq_?�da
CONSTRUCTION PERMIT APPLICATION JOB SU /An#
ADDRE
OWNER NAMENAME OF BUSINESS
PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
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MAILING ADD ESS LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP APP(Ovsd
Z-2— 2— q/ RW PerM Required
CML Streal Ugo permit Req'd
ZIP T9LEPHONF, EXISTING — PROPOSED Inspection Required
Sidewalk Required
REQUIRE FT underground
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REQ'D POSTED
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TAX ACCO NT PARCEL NO.
COMPLETE EXEMPT ALLOWED , PROPOSED ALLOWED ED
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Description 'TEE Description FEE
Plan Check State Surcharge
ILAZING % LOT SLOPE %
Building Permit City Surcharge
PLAN CIIECK N VESTED DATE Plumbing Base Be
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONL%t ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPILICATION: 180 DAYS
CL PERMIT UMM I YEAR - PROVIDED WORK 15 STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection
'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
a 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 Landscapeinsp. Total Amt. Due
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
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1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION Recording Fee Receipt # 1_�� F7 7-
GIVEN IS CORRECT; AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF APPLICATION APP—RO-TAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application Is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his/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.
WORKIMEN'S COMPENSATION INSUFL#CE AND RCW 18.27.
OFFICIALS SIGNATURE DATE
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AGE DATE S GNE7D (4-25)
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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-tSPECTOR"
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR
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DATE RECEIVED
PERMIT EXPIRES
PERMIT
CITY OF EDMONDS U" NUMBER
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JOB
CONSTRUCTION PERMIT APPLICATION ADDRESS��
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OWNER NAMENAME OF BUSINESS
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MAILING ADDRESS' LID FEE $
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REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CIIT�4 ZIP ITILEPHONE
NAM.E_._,_
ENGINEERING REVIEWED BY DATE
ADDR
7138,
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FIRE REVIEWED BY
DATE
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STATE LICENSE ER EXPIRATION DATE CHECKED BY
VARIANCE OR CU
SHORELINE OR ADS11 INSPECTION BOND
REQ'D POSTED
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SEPA REVIEW
SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO.
COMPLETE EXEMPI ALLOWED PROPOSED ALLOWED PROPOSED
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REMARKS
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REMARKS
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VALUATION
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Description
FEE
Descriptiort
FEE
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State Surcharge
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Building Permit
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PLAN C14ECK NO VESTED DATE
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Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURDS, SIDEWALKS. DRIMEWAYS, MARQUEES, ETC.) WILL REQUIRE
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SEPARATE PERMISSION.
Engr. Review
PERMrTAPPLICATION:- IWDAYS
PERMIT LIMM. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Fire Review
Plan Chk. Deposit
Ao�_
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND A14D HOLD HARMLESS THA CITY OP
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EDMONDS, WASHINGTON, IT$ OFFICIALS, EMPLOYEES, AND,AGE.NT4 1`9110141ANY AND
Fire,16spection
Receipt #
4 -;�3
,tisING DIRECTLY OR INDIRECTLY
FOR DAMAGES OF WHATEVER NATtJRE. AP
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY crTY ORDINANCE
Landsdapelinsp.
Total Amt. Due
NOR LIMIT IN ANY WAY THE CHYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION
APPNCWAL
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 application Is not a pormit until signed by the
TION; ANq IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
Building Official or Ws/har Deputy: and Fees are paid, and
IN VIOIA'VION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknowledged In space provided.
WORKMIEffS COMPENSATION INSU"CE AND RCAV 18.27.
OFFICIALS SIGNATURE DATE
SIG E I NER AGENT)
DATE SIGNED
Jeamageg�_
771-0220
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I
R D T
ATTENTIOW EXT 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'rFILA YELLOW- PISPECTOR
,00`�4ATE OF OCCUPANCY-14AS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD-ASSE
�03
PRESS HARD -YOU ARE MAKING 4 C PIVES