20050708.pdfDATE RECEIVED
A PERMIT EXPIRES i,-_>,1h
I. kRMIT
CITY OF. EDMONDS NUMBER
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CONSTRUCTION PERMIT APPLICATION JOB SUITE/APTF$
ADDRESS ICO
,:;7OWNER NAMEINAME OF BUSINESS 0 6— a4l
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MAILING ADDRESS 7
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z T ESCP Approwed 13
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required 13
0 fo Street use Permit Requited 13
CITY ZIP TELEPHONE EXISTING PROPOSED Inspection Required 0
Sidowall, Reritatred 0
REQUIRED DEDICATION FT unciergrouno 0
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NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
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JMD Y REQ*D COMPLE I TED I EXEMPT
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LA, GEOTECH REPORT
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Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE LOT SLOPE%_____7 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
I= 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)
W
a. PERMIT LIMIT. SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
APPLICAN . T. ON BEHALF OF HIS OR 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
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt H
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
E Landscapelnsp, Total Anil. Due
_j DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANC
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
x Recording Foe Receipt lif
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 Thisappl,cmion is nota imind tifild sionud by tho
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC. CALL Buildino Official or hisifunr Deputy and rutis are paid and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED . to( oift is acknowindijud III SINVII InOvidod
IN VIOLATION OF THE LABOR, CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
W NIS COMPENSATI"N RANCE AND RCW 18:27. DATE
OFFICIALS
DATEPIGNED (425) e 1)
'DA11
771-0220 r 7 1 ts ro W —y
AfTENTION EXT. 1333
IT IS UNLAWFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL FitF - YELLOW -INSPUCIOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 I IBC110 I IRC110, PINK -OWNFR - GOI0 - ASSESSOR
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FINAL PROJECT APPROVAL FORM