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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PLAT NAMEISUBDIVISION NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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NAME METER SIZE
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No. OF FIXTURES
PAY REQUIRED
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ADDRESS REMARKS
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OWNERMONTRACTOR RESPONSIBLE FOR EROSION CONT OUDRAINAGE
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FIRE REVIEWED BY DATE
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STATE LICENSE NUMBER XPIRATION RATE
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PROPERTYTAX ACCOUNT PLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
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DESCRIBE WORK TO BE DONE
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PROGRESS INSPECTIONS PER UBC 11081FINAL INSPECTION REaO
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VALUATION
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Description FEE Description FEE
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Plan Check
State Surcharge
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LOT SLOPE % Building Permit
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PLAN CHECK NO:
VESTED DATE Plumbing
THIS PERMIT AUTHORIZER ONLYTHE WORK NOTED. THIS PERMIT COVERS WORK TO
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Grading
DOMARI (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) LL ITEQUI -
VIA FIC
SEPARATE PERMISSION.
Engr. REVIEW
PER ITAPPUCATION: LOODAYS
PERMIT LIMIT. 1 YEAR,PIIOVID D WORK IS STARTED WITHIN ISODAVS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
LIT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chit. 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 III
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY on iNmRccTLY
PRO THE ISSUANCE 01 THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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Total Amt. Due
NOR LIMIT IN ANY WAY THE CITYS ABLITY TO ENFORCE ANY ORDINANCE PROVISION.-
Recording Fee
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN 13 CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHOR ZED AGENT OF
APP ICATION APPROVAL
THE OWNER I AGREE To C MPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
This rppll�fion 1, not 8 permit until signed by Me
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
to
IN VIOLAT N LAS ORANGE THE STATE 0 WASHINGTON RELATING TO
FOR INSPECTION
Building Official or his/her Deputy: and Fees are paid. and
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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
PaNK-OWNCR GOLD -ASSESSOR
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