20050647.pdf• DATE RECEIVED
[PERMIT EXPIRES
PERMIT
CITY OF EDMONDS NUMBER CMZ%j C'L
CONSTRUCTION PERMIT APPLICATION JOB SUITEIAPT#
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STATE LICENSE NUMBER EXPIRATIO DATE C gY VARIANCE OR Cu SHORELINE OR ADB# INSPECTION SEPA
REQ'D • COMPLETED EXEMPT
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ADDITION ❑ MIXED USE CHANGE OF USE i
❑REMODEL ❑ PARKING LOT AREA PLANNING REVIEWED BY DATE g
MULTIFAMILY ❑ SIGN REQ'D PROVIDED
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❑ REPAIR 1:1CYDS ❑ ( X FT.) REMARK Sri k I )
1:1 DEMOLISH 13 TANK ❑
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d(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN;
Tl'P F T UCTION GOCCROUPANT
LU NUMBER { NUMBER OF
42
OF I DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT.
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DESCRIBE WORK TO BE DONE
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rDescription FEE Description FEE
Plan Check State Surcharge
HEAT SOURCEss`sss7 LOT SLOPE% VESTED DATE
Building Permit City Surcharge
PLAN CHECK NO: Plumbing Base Fee �?)
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC Gradin
` DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g
t SEPARATE PERMISSION,
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
a PERMIT LIMIT: SEE ECDC 19.00,005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engf. Inspection '
"APPLICANTS 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
i 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 ON REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due
= 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 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• CALLBuilding Official or hislhor Deputy: and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VI THE LABOR OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided
WO MEN'S ENSATIO SU CE AND RCW 18:27.
OFFICIAL. •SIG ATURE ATE
SIG TU (OWNER0 A NT): DATE IGNtD� (425) T/
771 -0220 RELEASED BY (� ATE
A TEXT. 1333
IT IS UNLAWFUL TO USE OR CU A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEE MADE AND APPROVAL OR A CERTI- ORIGINAL -FILE YELLOW -INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 I IRC110. PINK .OWNER GOLD - ASSESSOR
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