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CITY OF EDMONDS Z
CONSTRUCTION PERMIT APPLICATION
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OWNER NAME/NAME OF BUS
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MAILING ADDRESS
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STATE LICENSE NUMBER EXPIRATIOND TE
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MBY
PROPERTY TAX ACCOUNT PARCEL NO.
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n NEW RESIDENTIAL PLUMBING) MECH
ADDITION COMMERCIAL N__.C�CE OR
CHANGE OF USE
REMODEL [3 MULTIFAMILY SIGN
GRADING FENCE
E] REPAIR 1:1 ryr).q ( x FT)
DEMOLISH 0 TANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
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CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR A ?91N:
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NUMBER
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NUMBER OF
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CRITICAL
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STORIES
UNITS
NUM13ER
DESCRIBE WORK TO BE DONE
HEAT SOURCE
GLAZING %
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LOT SLOPE %
PLAN CHECK -NO:
VESTED DATE
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
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DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE -
SEPARATE PERMISSION.
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PERMIT APPILICATION: 180 DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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*APPLICANT ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
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IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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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
13
DEEMED TO MODIF� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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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 COMPENSA2@111N�U RANCE AND RCW 18.27.
S, RE 6 0 �A
DATE SIGNED
SE PERMIT
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NUMBER
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SUITE/APT#
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PLAT NAME/S UB DIVISION NO.
LOT NO.
LID NO.
LID FEE S
3UBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required
street Use Permit Roq'i
EXISTING PROPOSED
inspection Required
Sidewalk Required
REQUIRED DEDICATION— F1
Underground
Wiring required
METER SIZE
LINE SIZE
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NO. OF FIXTURES.
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PRV REQUIRE
YES C3 No
NGINEERING
DATE
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LOT COVERAG=
iLLOWED PROP
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PARKING L
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'HECKED BY JTYPF CAFJu0fff rm" 1. :7 (A-
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GROUP 'ot
SPECIAL INSPECTION JKREA OCCUPANT
REQUIRED [:] YES LOAD
Descript 7on
Plan Check
Building Permit
Plumbing
Riln^hnni�nl
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapeinsp-
Recording Fee
DUIIUIIIU U1116101 U1 --Pu�Y- - - --- --- t' .... ..
FOR INSPECTION receipt Is acknowledged in space provided.
OFFICIALS SIGNATURE D
(425) \LL 11juns-
771-0220 IRELEASEd BY JATE V
ATTENTION 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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