20050348.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEiNAME OF BUSINESS
MAILING ADDRESS
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NAME
[PERMIT EXPIRES
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NUMBER
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PLAT NAME/SUBDIVISION NO.
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Appio,,d
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EXISTING PROPOSED____
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inspection Requited
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STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY
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PROPERTY TAX ACCOUNT PARCEL NO. U/ WAIVER [3 ALLOWED PROPOSED ALLOWED PROPOSED
STUDY
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REPAIR ED CYDS 1:1 A FT.) REMARKS
DEMOLISH TANK OTHER
EGARAGE RETAINING WALL FIRE SPRINKLER
] CARPORT ROCKERY FIRE ALARM
(TYPE OF USE. BUS114ESS OR ACTIVITY) EXPLAIN:
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NUMBER 'T4UMBER OF
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Description
FEE
Description
FEE
Plan Check
State Surcharge
HE T SOURCE
LOT SLOPE%
VESTED DATE
W
50
7
1
-
Building Permit
City Surcharge
11
PLAN CHECK NO:
Plumbing
Base Fee
2A .
06
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)
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
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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..
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
10�
APPLICATION APPROVA
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-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
CALL
Building official or hisJher Deputy: and Fees are paid. and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION 1!(�URANCE AND RCW 18:27.
FICIA Un^ DATt
sl WNER OR r AiG
DATE SIGNED
(425)
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ATTEKTION 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 I IBC110 i IRC110.
110104 PRESS HARD - YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK -OWNER GOLD - ASSESSOR
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