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USE PERMIT--,T� — 0 %1
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CONSTRUCTION PERMIT APPLICATION JOBS TE/APT#
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OWNER NAME/NAME OF BUSINESS
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❑ NEW RESIDENTIAL UMBIN ECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FL)
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(TYPE OF USE, BUSINESS AClp( XPLAIN:
CHECKED BY TYPE ST U ION CO OCCUPANT
FE GROUP
NUMBER NUMBER OF CRITICAL 1 9.: )
OF DWELLING AREAS SPECIAL INSPECTION AREA OCCUPANT
OSTORIES2. UNITS NUMBER REQUIRED ❑YES LOAD
DESCRIBE WORK TO BE DONE
REMARKS
r PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D 9
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Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE G LAV % I V LOT SLOPE %
Building Permit / City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing L
Mechanical 2
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
!: BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION,
Engr. Review
Lu PERMIT APPLICATION: 180 DAYS
CLI PERMIT LIMIT. 1 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
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 �'r
9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt, Due
O 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- CALLThis application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees aro paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION A, receipt is acknowledged In space provided.
WORKMEN'S COMPENSATION INSURANCE AND. RCW 18.27. FhCTE
OFI-A^L-S IGNA URE
SIGNATURE R OR AGENT) DATE SIGNED
(425)
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771 0220 RELEASED BY ( l
ATTEATIOW 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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