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Description FEE Description FEE
Plan Check State Surcharge
HEATSOURCE LOTSLOPE% VESTED DATE
Building Permit 210 City Surcharge
PLAN CHECK NO: Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC Grading
DONMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION. Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
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0. PERMIT LIMIT: SEE ECDC i9.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Fire Review Plan Chk. Deposit
cn APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
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Lu INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
_1 IN INTEREST. AGREES TO
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
x FROM THE ISSUANCE OF THIS PERMIT. ISSIJANCE OF THIS PERMIT SHALL NOT BE
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.,
9 Recording Fee Receipt # I JP '14 12%
1 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
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THE OWNER. I AGREE TO COMPLY WITH CITY AND CALL Building Otricial or his/her Deputy: and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED T S EBY, NO RSON WILL BE EMPLOYED
T SHINGTON RELATING TO receipt is acknowledged in space provided
IN VIOLATION OF THE LABOR C BE F TH STATE OF FOR INSPECTION
WORKMEN;q Cojrf��ATION INSU N E AN JCW 118:2�7. 0 S IGNA U E PATE ,
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SIGNED
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771-0220 LEASE BY
ATTj1q_jNTION EXT. 1333
IT IS UNLAWFUL TO USE 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. UBC109 / IBC110 I IRC110. PINK -OWNER GOLD - ASSESSOR
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REMNSPECTED OUTSTANDING. ISSUES - GRANT RNAL PROJECT APPROVAL
Date Signature
1:tcnip:b1dg:fornis:ocaprv1 3/25/04