20040961.pdf - LEGACYFDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PERMIT EXPIRES
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PERMIT -70
NUMBER
JOB SUITEIAPTO
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PLAT NAME) SUBDIVI SION NO.
LOT NO
LID NO
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET IMAP
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MIXED USE CHANGE OF USE PARKING
REMODEL MULTIFAMILY SIGN REQ'O I PROVIDED
GRADING FENCE
REPAIR CYDS x FT.) REMARKS
DEMOLISH E] TANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT El ROCKERY FIREALARM
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NUMBER NUMBER OF
DWELLING SPECIAL INSPECTION
OF
STORIES UNITS REQUIRED 13 YES
DESCRIBE WORK TO BE DONE
EREMARKS
GEOTECH REPORT
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STRUCTURAL DESIGN
BY:
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SHORELINE OR ADB# I INSPECTION SEPA
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Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT �OURCE
LOTSLOPE%
VESTED DATE
rBuilding Permit
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City Surcharge
PLAN CHECK NO:
Plum i g
Plumbing
t:E;1
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
Grading
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC i9.00.0051A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
*APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
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
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
!I NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
-214 n
Landscapeinsp.
Total Amt. Due
Recording Fee
Receipt #
7
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
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 CONSTRLIC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATI�ONOF T HE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN NSATION INSURANCE AND RCW 18:27.
CALL
FOR INSPECTION
(425)
771 -0220
APPLICATION APPROVAL
This application is not a pernut until signed by the
Building Official or hisitier Deputy and Fees are paid. and
receipt is acknowledged in space provided
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DATE SIGNED
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ATTEATION RE UNTIL C:A 1. 1 JJJ
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTU
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 I IRC110.
10/04 PRESS HARD - YOU ARE MAKING 4 COPIES
ORIGINAL -FILE YELLOW -INSPECTOR
PINK -OWNER GOLD - ASSESSOR
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