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THIS PERMIT AUTHORCEES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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Description
FEE Description, FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
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Building Permit
City Surcharge —
45—,
PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PFAMIT AUTHOR[ZES ONLV THE WORK NOTED. THIS PERMIT COVERS WORK TO
ft BE DONE ON PRIVATE PROPER7Y ONLX ANY CONSTRUCTION ON THE PUBLIC
3
Grading
3 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
t: SFPARATEPERMISSION.
Engr. Review
PFRILITTAPPLICATION: IGO DAYS
PERMIT LIIIAM I YEAR - PROVIDED WORK 15 STARTED WITHIN 180 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
EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
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
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Total Amt. Due 1� 51
NOR LIMIT IN ANY WAY THE CrTY8 ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
ss�
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH C17Y 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 hIsjUr Deputy: and Fees we paid. and
IN VIOLATION OF THE E OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is ack.nowledged In space provided.
WORKMEffS COMPENSA I NCE AND RCW 18.27.
OFFIC!%&SI DATE
0 DATE SIPNED
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771-0220
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RELEASED BY_ DATEI
ATTENTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECT, ION 109 PINK -OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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