20050649.pdfDATE RECEIVED
D-5 FPERMIT EXPIRES 67
PERMIT obs-, A/
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CITY OF EDMONDS NUMBER 1 (-1
CONSTRUCTION PERMIT APPLICAT107N JOB
F7 ADDRESS S �,"74
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NO. LID NO
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ADDRESS
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GRADING CYDS
DEMOLISH
TANK
GARAGE
RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE. BUSINESS OR ACTIVITY1 IZXPI.44�
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TISCP Approved E3
RW Parma Required 13
EXISTING PROPOSED
Street use Permit Required 0
Inspection Required C3
Siclawaik Required [3
REQUIRED DEDICATION FT
underground C3
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FRONT LIRSIDE REAR
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0
0
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NUMBER
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NUMBER07
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UNITS
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REQUIRED DYES
DESCRIBE WORK TO BE DONE'
REMARKS
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Description
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_12�an Check
HEAt SbORCE
LjSLOPt/6
VESTED DATE
Building Permit
PLAN CHECK NO:
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS. DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Grading
Engr. Review
UJI
0.
PERMIT APPLICATION: SEE ECDC I 9.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 19-00.005(A)(6) �
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
*
*
I
*A PPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLE) HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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 OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
--- — M
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE 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-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S PPMPENSATION INSURANCE AND RCW 18:27.
CALL
FOR INSPECTION
SIG TUR WNEIR A
DATE S NED
Co!,Y� I OCCUPAN
G ROUP
CONSULTANT OCCUPANT
LOAD
FEE Description
State Surcharge
City Surcharge
0101) Base Be
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his1hor Deputy! and Fees are paid, and
receipt is acknowledged in space provided
771-0220 RELEASI
ATTENTION EXT. 1333
IT IS UNLAWFUL TO USt� OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1091 IBC110 / IRC110.
10/04 PRESS HARD - YOU ARE MAKING 4 COPIES
DATE
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