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[PERMIT EXPIRES
PERMIT
CITY OF EDMONDS NUMBER
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CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
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OWNER NAME/NAME OF Bus' NESS .01
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO
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Si(eel Use Permit Required 13
CITY zip TELEPHONE EXISTING PROPOSED inspection Required 13
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REQUIRED DEDICATION FT
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STrE'Ll-CENSE NUMBER EXPIRATION DATE VARIANCE OR CU SHORELINE OR ADEI# INSPECTION 77A
CHECKED BY REO*D COMPLETED EXEMPT
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ADDITION o COMPLIANCE OR
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REMODEL PARKINGVIDED LOTAREA PLANNING REVIEWED BY DATE
MULTIFAMILY SIGN REOID PRO 016
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REPAIR E] CYOS 1:1 X FT.) REMARKS
*EMOLISH TANK OTHER
GARAGE o RETAINING WALL E:] FIRE SPRINKLER
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(TYPE OF USE, BUSINESS QR ACTIVITY) EXPLAIN: 01
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DESCRIBE WORK TO BE ONE REQUIRED 13YES
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STRUCTURAL DESIGN
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Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE LOT SLOPE7____F VESTED DATE
Building Permit City Surcharge
CHECK tLO: Plumbing Base Fee
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
9 DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS,.MARQUEES, ETC.) Wl LL REQUIRE Grading
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2 Engr. Review
W 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
Fire Review Plan Chk. Deposit
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
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_j IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
M EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection
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ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
_j DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION.&
Recording Fee Receipt # 1 .46
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 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
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided
WORKMEN'S C��,ATION INSURANCE AND RCW 118:27.
OFFICIA�,S SIGN
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SIGNAT (OWNER e_7
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RELEAEFEDtK IF�ATEI
ATTENTION 4' EXT. 1333 =2��
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL ---- I .....
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