20050690.pdfDATE RECEIVED PERMIT EXPIRES
PERMIT 0696
CITY OF EDMONDS INUMBER
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CONSTR7UCTION PERMIT APPLICATION JOB SUITE/APTP
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NAME
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FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required
street use Permit Required
EXISTING PROPOSED
inspection Required
Sidewatk Required
REQUIRED DEDICATION, FT
Unciefground
Wienri required
METER SIZE
L INE SIZE
0. OF FIXTURES
PRV REQUIRED
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YES E3 NOM
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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OSED SETBACKS (FT.)
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ADDITION COMPLIANC OR
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PLANNING REVIEWED BY DATE
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GRADING FENCE
0 REPAIR CYDS x FT.)
REMARKS
DEMOLISH 0 TANK OTHEN,,(
GARAGE RETAINING WALL FIRE SPRINKLER
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(TYPE OF USE, BU ACTIVITY) EXPLAIN:
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NUMBER OF
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Descriptionl
FEE
Description
FEE
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Plan Check
State Surcharge
HEAT SOURCE LOTISLOPE% VESTED DATE
Building Permit
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City Surcharge
PLAN CHECK NO:
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Plumbing
66
Base Fee
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Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Grading
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
Engr. Revie
SEPARATE PERMISSION.
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
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'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSOR S
Fire Review
Plan Chk. Deposit
Fite Inspection
Receipt #
2
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD 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
ISSUANCE OF THIS PERMIT SHALL NOT BE
FROM THE ISSUANCE OF THIS PERMIT. NCE
DEEMED TO MODIFY, W41VE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINA
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Total Amt. Due
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NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Recording Fee
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Receipt N
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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 nULY 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/her Deputy: and Fees are paid, and
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
. receipt is acknowleqged in space provided
FOR INSPECTION
WORKMEN -4oeCIWNTN SATION INSURANCE AND RCW 18:27.
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771-0220 AT
EXT. 1333
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ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CE RTI-
RI I L - FILE LLOW -INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 if IRC110.
Opt I -OWNER OLD - ASSESSOR
10104 PRESS HARD - YOU
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