20050218.pdfDATE RECEIVED
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PERMIT
CITY OF EDMONDS NUMBER ct,_:z I
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CONSTRUCTION PERMIT APPLICATION JOB SUITEIAPT#
ADDRESS Ciir. 744
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NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
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GEOTECH REPORT
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Description FEE Description FEE
_Ij Plan Check State Surcharge
ESTED DATE Building Permit City Surcharge C)
HEATSOURCE LOTSLOPE%
PLAN CHECK NO: Plumbing C)() Base Fee 30 C6
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MAR QUEES, ETC.) WILL.REQUIRE Grading
SEPARATE PERMISSION. Engr. Review
W PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT' SEE ECDC 19.00,005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) S AND SUCCESSORS Fire Review Plan Chk. Deposit
APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGN
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
0: ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
4
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
a NCE Landscapelnsp. Total Amt. Due
-i DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINA
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 INFORMAT16N 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 Off iciai 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 COMPENSATION INSURANCE AND RCW 18:27. �_O_FFTCKLS S12NATUR DATE
SIGNATUR EV A DATESIGNED (425)
1> 3- 6- 6t)
RELEASED11T DATE
771-0220
ATTE (ON EXT. 1333
IT IS LIN AWFUL To U/E OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL -FILE YELLOW -INSPECTOR
FICATE OF OCCUPANCY HAS BEEN. GRANTED. UBC1091 IBC110 / IRC110. PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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