20050139.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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Description FEE Description FEE
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I I I Building Permit City Surcharge
PLAN CHECK NO: Plumbing Base Fee
ORK TO Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS W
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC Grading
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION. Engr. Review
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PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
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0. PERMIT LIMIT. SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
0 S Fire Review Plan Chk. Deposit
(A OAPPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESSOR
UJI IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDM NDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
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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 Am(. Due
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0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMAf ION APPLICATION APPROVAL'
GIVEN IS CORRECT; AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF This application is not a permit until signed by the
THE OWNER. I AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building Official or his/her Deputy: and Fees are paid. and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED receipt is acknowledged in space provided
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
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SIGNAJ3*E (OWN M(RNTj ..,T5SI.GN9D (425)
0 771-0220 RELEASED BY. IDA�u
EXT. 1333
ATTENTION DING OR STRUCTURE UNTIL
IT IS UNLAWFUL TO USE OR OCCUPY A BUIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL FILE YELLOW INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 I IRC1110. PINK -OWNER GOLD ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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MEMORANDUM
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Date: 03/30/05
To: Nicole Daniels, Accounting Assistant
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from: JoAnne Zulauf
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Subject: REFUND
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Nicole, please prepare a refund check in the amount of $65-00. Washington Energy Services.
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made a duplicate payment on the Rattray residence, permit 2005-0139. Please mail the check to
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WESC at 2800 Thorndyke Ave W, Seattle WA 98199. Please deduct $50.00 out of the building
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fund and $15 from the city surcharge fund. Pleas e note that WESC paid for several permits on
closed a copy of bur recei t #25791 for your records.: Thank you.
this receipt. I have en p
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Sincerely,
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Jo e Zulauf
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City of Edmonds (Q Cohimunity Services
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Street Disruption Fee. (111 Fund)
Storm Drainage Fee Cn
Engineering Inspection Fee (SFR) 0 _n
Engineering 22% inspection Fee (SP, Multi. Comm) h
Engineering Review Fees (SP, Multi. Comm) M M
ROW/Street use/Encroachment Permit 0
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Reimbursable Consulting Fees
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Critical Areas
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�EPA Review Fee
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horeline Permit Fee
11,�,*, sign installation (620 Fund) 0
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Maps / Books
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City Surcharge
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State Surc
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