20050592.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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Description
FEE
Description
FEE
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Plan Check
State Surcharge
HEAT SOURCE
LOTSLOPE%
VESTED DATE
Building Permit
City Surcharge
PLAN CHECK NO:
Plumbing
Base Fee
Mechanical
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Grading
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUI31C
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)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
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'APPLICANT ON BEHAL F OF HIS 00 HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
Fire Review
Plan Chk. Deposit
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- IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
51—
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
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; THATTHE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
T QN; AN G THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN T11 N OF LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
VIOL TION OF I
WORK E2N,jt0fAqEjNTION INSURANCE AND RCW 18:27.
APPLICATION APPROVAL
This application is not a permit until signed by the
CALL Building Official or hislhor Deputy: and Fees are paid. and
receipt is acknowledged in space pirovided,
FOR INSPECTION
OFF2S r TUR
(425) 1N Ai JATE
771-0220 dATE
;SIGN IE WN RAGENT):
DATE SIGNED
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.
ORIGINAL - FILE - YELLOW - INSPECTOR
PINK -OWNER - GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE
MAKING 4 COPIES
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