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Description
Plan Check
HEAT SOURCE
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VESTED DATE
Building Permit
PLAN CHECK NO:
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Grading
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BE DONE ON PRIVATE PROPERTY, ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
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PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT. SEE ECDC 19.00.005(A)(6)'
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
"APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSOR S
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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 ORDINANC E
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
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Recording Fee
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
FOATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PLAT NAMEISUBDIVISION NO.
LOT NO.
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING PROPOSED
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REMARKS
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ENGINEERING REVIEWED BY
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PLUMBING MECH
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
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(TYPE 1.1.1SE.BUSINE,�SgRA TIVITYIFXPLAIN:
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OCCUPANT
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THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL
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
WORKMEN'S COMPEN RANCE AND RCW 18:27.
SIGNA U!E(QW EIROR VG DATE SIGNED (425)
771-0220
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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 CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110.
ANT
GROUP
FEE Description FEE
State Surcharge
City Surcharge__
Base Fee
Plan Chk. Deposit
Receipt N
Total.Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK -OWNER GOLD - ASSESSOR
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—PLANNING DIVISION DATE—
I'LLUE SIGN
PROJECT
SITE ADDRESS 39 17,
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PERAMUT —ADB# —DATE INSPECTED —
DESCRIPTION OF WORK TO BE INSPECTED 06CO 51 VA, 7 /V
A field inspection was conducted to determine compliance with approved plans. Final approval denotes that
there arepo objections from the above signed Department to the. granting of
Final- approval of the described work
—Performance Bonds associated with the project may be released
GRANT FINAL PROJECT APPROVAL
GRANT FINAL PROJECT APPROVAL WITH CONDITIONS NOTED
—FAILED FINAL INSPECTION - OUTSTANDING ISSUES
2.
3.
_RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL-PROJ`ECT APPROVAL
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