20050267.pdft I DATE RECEIVED -,,I
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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TESCP Approved E3
RW Permit Required E3
Street Use Permit Required
Inspeclion Required
Sidewalk Required
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Witirin requifed C3
PRV REQUIRED
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NEW ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR 0
ADDITION COMMERCIAL COMPLIANCE OR
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PARKING LOT AREA PLANNING REVIEWED BY DATE 5
REMODEL MULTIFAMILY SIGN REO'D PROVIDED
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REPAIR CYDS x FT.) REMARKS
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DEMOLISH TANK
GARAGE o RETAINING WALL FIRE SPRINKLER
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VALUATION
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE LOTSLOPE% . VESTED DATE Building Permit City Surcharge
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PLAN CHECK NO: Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVE Mechanical
RS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
:E Grading
DONMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
_j SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
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PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
*APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
W
_j 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 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 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 DOIN W RK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
THIEE STATE OF WASHINGTON RELATING TO receipt is acknowledged in space provided.
P
IN V19AATION Of TH LABOR CODE OF THE FOR INSPECTION
Wofyffy 's CytPEN lo�,�RANCE AND RCW 18:27. OFFICI 71iGN U E DiAT E j
ENT): DATE SIGNED (425)
S N Ef(INER , '05- -0220
77 j A 3 0 a 771 RELEASED Bf DAT9
ATTENTION EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CtRTI- ORIGINAL - FILE - YELLOW INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRAN"rED. UBC109 / IBC110 I IRC11.0- PINK -OWNER GOLD I ASSESSOR
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