20051029.pdfDATE RECEIVED
/ PERMIT EXPIRES
PERMIT
CITY OF EDMONDS ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
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OWNER AME/NAME OF BUSIIJESS
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QPUBLIC RIG14T OF WAY PER OFFICIAL STREET MAP RW Permit Required
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Strout Use Permit Rsq'd Q
CITY ZIP TELEPHONE EXISTING •_-_ PROPOSED Inspection Required Q
Sidewalk Required Q
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Wiring required Q
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
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ADDRESS REMARKS z
U OWNER/CONTRACTOR RESPONSIBLE FOR EROSION ONTROUDRAINAGE z
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STATE LICENSE NUMBER EXPIRATION DATE CaCCK gY VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND j
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❑ GARAGE ❑ RETAINING WALL13FIRE SPRINKLER
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(TYPE OF USE USINESS OR ACTIVITY) EXPLAIN:
V CHECKED BY ITYP UCTION C OCCUPANT = 1
GROUP E2 M
c NUMBER NUMBER OF CRITICAL v
OF DWELLING AREAS SPECIAL INSPECT N AR OCCUPAN
o STORIES � UNITS NUMBER REQUIRED ❑,YES LOAD n
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REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D 9` Z
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Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing Base Fee
Mechanical '
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
C BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
I. SEPARATE PERMISSION.
2 Engr. Review
LuPERMIT APPLICATION: 180 DAYS
PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN Iso 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
Q EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
a 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 OH REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp.Total Amt. Due
= NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee Receipt #
I THAT I HAVE READ THIS APPLITHAT THE
GIVEN HEREBYISCORRECT; AND THAT I AM THE OWNER, OR THETDULY AU HOR Z DFON AGENTIOF APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• CALL This 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 are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO R INSPECTIO receipt is acknowledged in space provided.
WORKMEN'S COMPENSAJAPkSLVANCE AND RCW 18.27. -
OF IC ALS SIGNATURE DTE
SIGNATURE(OWNER R EN DATE SIGNED (425)
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CO.
771-022 RELEASED BY D t
ATTENTION EXT 13 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 - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109 PINK - OWNER GOLD -ASSESSOR
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