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PERMIT
CITY OF EDMONDS
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Pemidl Requited
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inspection Requited
Sidewalk Required
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Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE
Building Permit City Surcharge
PLAN CHECK NO: IS Plumbing Base Fee
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Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIV . ATE 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)
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IL PERMIT LIMIT. SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
&APPLICANT. ON BEHALF OF HIS Oil HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
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_j IN INTERESTj AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
04� ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY I
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE t 0
0 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE LandscapeInsp. Total Amt. Due
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 INFORMATION Tp�p L �1
CATION 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 W KAUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED receipt is acknowledged in space provided
IN VIOLATION OF THE LA 0 CPDE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
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WORKMEN'S COMPENSATIT)RNSgRANCE AND RCW 18:27. OF CIALS SIGNATURE DATE
StGM DAT SIGNED (425)
RE (OWNER ORA
771-0220 RELE EDEW
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ATTENTION EXT. 1333 __>
IT IS UNLAWFUL TO USE OR 0 C I CUPY A BUILDING OR STRUCTURE UNTIL I I ("
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- INAL FILE YELLOW - INSPECTOR
OR] i�l
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 f IBC110 I IRC110. PIN�K- GOLD -ASSESSOR
10104 PRESS HARD YOU ARE MAKING 4 COPIES
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