20050245.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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STATE_�ICENSE M13ER EXPIRATION DATE/ CHECKED BY
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PROPERTY TAX ACCOUNT PARCEL NO.
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ADDITION COMMERCIAL
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REPAIR CYDS ( x FT)
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GARAGE RETAINING WALL FIRE SPRINKLER
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PLAN CHECK NO.: I VESTED DATE
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.
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFN� DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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 MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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 THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
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
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
SIGVURE HOWN6. f R T" DATE SIGNED
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PLAT NAME/SU BDIVI SION NO. LOT NO. LID NO.
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3( LID FEE$
TESCP Approved
PU13LIC RIGHT WWAY PER OFFICIAL STREET MAP RW Paunit Required
Street Use Permit Roq'd
EXISTING _(_=9gQe,;rpROPOSED inspection Required
sidewalk Required IAI
REQUIRED DEDICATIOL�FT underground
Wifing required
METER SIZE LINE SIZE NO. OF FIXTURES PAV REQUIRED
it I V 1 14S7 YES 13 NO,;W
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REO'D
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VALUATION
Description FEE Description FEE
Plan Check I A� I State Surcharge
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Mechanical
Grading
Engr. Review
Engr.'Inspection._
Fire Review PlanChk.Deposit
Fire Inspection Receipt #
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Landscapelnsp. Total Amt. Due
Recording Fee Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
CALL Building Official or his/her Deputy: and Fe. -!s are paid, and
FOR INSPECTION receipt Is acknowledged in space provided.
C S SIGNAT�JE DATE
(425) vm
771-0220 - RE ED By VATE
ATTENTION EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL �44
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- OAII�Al_ - FILE - YELLOW/ IN SPEO`(01�
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER - 001 n . ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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FINAL PROJECT APPROVAL FORM