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DATE RECEIVED
/r7CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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REMARKS
PROGRESS INSPECTIONS PER UBC 108/1130091IRC109 FINALINSPECMN REITLY
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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 /:2
001
VESTED DATE
PLAN CHECK N06q
Plumbing Base Fee
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Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t= BE DONE ON PRIVATE PROPERTY ONLI ANY CONSTRUCTION ON THE PUBLIC
Grading
2
3 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
I= SEPARATE PERMISSION.
Engr. Review
2
I PERMIT APPLICATION: 160DAYS
IL PERMIT UMIT: 1 YEAR - PROVIDED WORK 18 STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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 MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapeinsp. Total Amt. Due
NOR LIMIT IN ANY WAY THE CITTS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
zi'APPLICANT,
Recording Fee Receipt #
I HERE13Y 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 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
IN VIOLATION OF-149 LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
Building Official or his/her Deputy: and Fees are paid, and
FOR INSPECTION receipt is acknowdodged In space provided.
WORKMEN'S C PPVENI�ATION INSURANCE AND RCW 18.27.
LALS SIGNATURE DATE
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SIGNATURE AE R AGENT) DATE SIGNED
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ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU- O=Wje YELLOW - (NSPEdd'TOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/iRC110.
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PNK- ER GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE
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