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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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FIRE SPRINKLER
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FIREALARM
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ESS ORACTIVITY) EXPLAIN:
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NUMBER
NUMBER OF
OF
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LID FEE S
7ESCP Approved
RW Pernid Required
Street use Permit Required
Inspection Required
Sidewalk Requited
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PRV REQUIRED
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DATE
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Description
Plan Check
HEATSQURCE LOT SLOPET ------ FVESTED DATE Building.Permit
PLAN CHECK NO: Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO rz
* 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)
uj
PERMIT LIMIT: SEE ECDC `19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
(n 'APPLICANT. ON BEHALF
ui
_1 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 #
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 Landscapelnsp. Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
9 RecordjoIg-1--ee--�_ Receipt # Z,n 39L,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPRdVAL
GIVEN 15 CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGE This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONS CALL Building Official or his/her Deputy: and Foosare paid. and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED SPECTION receipt is f0m)WIedged in space provided
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING T FOR IN
WORKMEN'S COMPENSATION INSURANCE AND RCW `18:27. TO
CIALS S AT E DATE
SIGNA&E� "WN OR A�ENT): OED, (425) -2
DATE SIG -7
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I I— I f - R LEASEARY I k / I I DATE
ATTENTIONV'/' EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTI
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110.
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