20050523.pdfDATE RECEIVED
16 PERMIT EXPIRES
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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STATE LICENSE NUMBER EXPIRATI N DATE REQ'D COMPLUTED I EXEMPT ,
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PROPERTY TAX ACCOUNT PARCEL NO.
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ADDITION COMMERCIAL COMPLIANCE OR 3.;
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PARKING LOT AREA PLANNING REVIEWED 13Y DATE
REMODEL MULTIFAMILY&jfy�� SIGN REQ'D I PROVIDED
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CYDS x FT.) REMARKS
DEMOLISH TANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
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(TYPE OF USE. BUSINESS OR ACTIVITY �EXPLAIN:
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In addition to the reguired
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VALUO"A"" i all not water tanks,
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$ UPC 60
Description FEE Description FEE
Plan, Check State Surcharge
HEATSOURCE LOTSLOPF% VESTED DATE Building Permit City Surcharge
PLAN CHECK NO: Plumbing .1 Base Fee
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Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NZTED. THIS PERMIT COVERS WORK TO
t= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
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
OAPPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
U) E CITY OF
ui
i IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS TH
a 2 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
'9 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.-
9 Recording Fee Receipt #
I 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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building Official or his/hor Deputy- and Fees ate paidr and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED receigit is acknowledged in space pfavided
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S COMP EN S;��%IN SU RANCE AND RCW 1111:27. 0 IC S N URE qNT E
SIGNATU (OWNER AGENT DATE SIGNED (425)
L C44-4 771-0220 RELEASE DATE
04TION EXT. 1333
IT IS UNLAWFUL TO USE OR OCC4)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
10104 PRESS HARD - You ARE MAKING 4 COPIES
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