20050420.pdfDATE RECEIVED PERMIT EXPIRES
PERMIT
CITY OF EDMONDS NUMBER r9_ 0%
CONSTRUCTION PERMIT APPLICATION JOB
ADDRESS
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Description
FEE
Description
FEE
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Plan Check
State Surcharge
HEAX.SOM, LOT SLOPEi. VESTED DATE
Building Permit
City Surcharge
00
PLAN q9ECK NO:
Plumbing
Base Fee
36. nb
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Grading
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
Engr. Review
SEPARATE PERMISSION.
2
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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
V,
'APPLICANT, . ON BEHALF OF HIS . OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
Fire Review
Plan Chk. Deposit
V
U IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
i EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
cc OR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
ALL C AIMS IF
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
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Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
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Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
APP AT'
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 ate paid. and
g 0 lal or 0
TION; AND IN DOING THE WQRK-AUT HORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE?kg-BOR C()bE OF THE STATE OF WASHINGTON RELATING TO
.
FOR INSPECTION
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receipt is acknowladged in space provi ad
WORKMEN'S C P SL NCE AND RCW 18:27.
OF IAL GNATUR DATE
SIGNATU DATE IGNE
R 0 E A 1,
(425)
771-0220
I�ELEASED 17 DATE
AT E 'PON CA 1.
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 / IRC110. PINK - OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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