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PERMITEXPIRES 12/1
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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OWNEFUCONISACTOR RESPONSIBLE FOR EROSION CONTROVORAINAGE
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STATE LICENSE NUMBER EXPIRATION DATE
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REMARKS
PROGRESS INSPECTIONS PER UBC 100/FINAL INSPECTION REO`O
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Description—
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Description
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Plan Check
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Building
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PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORUIS ONLY THE WORK NOTED. THIS PERMIT COVER WORK TO
I: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ONTME PUBLIC
2 DOMAIN
Grading Recording Fee
Z, (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC,) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review City Surcharge
PERMIT APPUCATION: 100 DAYS
In
PERMIT LIM I I YEAR - PROVIDED WORK 15 STARTED WITHIN INDAYS
Engr. Inspection State Surcharge
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
"APPLICANT, ON BEHALF 01 HIS 01 HER SPOUSE, HIIRI. ASSIGNS AND SUCCESORS
Traffic Mitigation 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
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Fire Review Receipt III
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I... THE ISSUANCE OF THIS PERMIT, IEEUMCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFX WAIVE OR REDUCE ANY EQUIREMENTOFANYCITNORDINANCE
Fire Inspection Total Amount Due _r
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NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
-
Landscapelturin Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECr. AND THAT AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL This application Is net a perehillnetil signed by the
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
Building Official or Maine, Deputy: and Fees arep0d, and
FOR INSPECTION 1—Iro I...-kn—Ise,ted ff,sPsc.P'Pld
WORKMENS COMPE�SATIO E AND RCW 18,27.
OR AGENRV ATE SIGNED
(425) OF IALS SIGNATURE
,IGNATUR
771-0220
REM DATE
F..'2112FUL
EXr 1333
E OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221 .
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTiFI.
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109
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