20050509.pdfDATE RECEIVED
. CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PROGRESS INSPECTIONS PER UBC joe/FINAL INSPECTION REOID
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FEE
Description FEE Description
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PLAN C'J�--CK NO: VESTED DATE Plumbing Base Fee -OL
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
1= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180 DAYS
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IL PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
(n OAPPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF Fire Inspection Receipt #
2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
M CTLY OR INDIRECTLY
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRE
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapelnsp. Total Amt. Due]
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NY CITY ORDINANCE
_j DEEMED TO MODIFN� WAIVE OR REDUCE ANY REQUIREMENT OF A
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- C ipt #E
Receipt #
Recording Fee
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION AP
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 is/her Depuly� and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official of h
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged In space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. OA� IAL S NAT RE DATE
SIGN4ATUIRIEN R 'AGE DATE SIGNED (425)
771.0220 RELEA D DATE
ATTE EXT 133*2
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
ORIGINAL - FILE YELLOW - INSPECTOR
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIF1 PINK -OWNER COLD -ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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