20040730.pdfDATE RECEIVED�,
C1W OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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Street Use Permit Roq'd E3
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EXIS1 ING PROPOSED
inspection Required
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NO. OF FIXTURES
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REMARKS
OWNII TRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAFNAGE
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
W PERMIT APPLICATION: 180 DAYS
CL PERMIT LIMIT., I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANI, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WI IATEVER NAT LIRE, ARISING DIREC FLY OR INDIREC I LY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF IHIS PFHMII SHALL NO] 13E
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
= 0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION"
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INFORMATION
GIVEN IS CORRECT. AND 114AT I AM THE OWNER. 013 THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRILIC
TION AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VI'6LATION OF THE LA13OR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW I B 2T
SIGN:f�U (OWNER R AnENr) DATE SIGNED
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VALUATION
I 11377-
Description FEE Description FEE
Plan Check J'70 7 State Surcharge �D r"
Building Permit C) City Surcharge
Plumbing elf Base Fee
Mechanical 1/0
Grading
Engr. Review
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Engr. Inspection .00 2 q-
Fire Review Plan Chk. Deposit 170:;,
Fire Inspection Receipt #
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Landscapelnsp Total Amt. Due
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Recording Fee RecEeipt# I
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APPLICATION APPROVAL
I his application is not a POrmit until signed by the
CALL Building Official or his/her Dernity: and Fees are Paid, and
FOR INSPECTION reevirit is acknowledged it, sPace provided.
3
(425) IGN r;jLIF DATE
771-0220 RFL 3Y
ATTENTION
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DATE
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
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PIZOP05ED MPG. i�i9VERA6E - 2,012
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I'ROPO')ED DRIVEWAY GOVEKA6E 1,402
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PERMIT COUN-T�F
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p�%PPROVED AS NOTED
BY ENGI�EERING
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L-OT AREA: 33,Zqq c.70.]`T.
L-ol %-OFE: 2 PERGENT IN M06. ENVEWPE
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