20050732.pdfI
0 1 DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEMAME OF BUSINESS
MAILING ADDRESS
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NAME
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USE PERMIT
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PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
I LID FEE$
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
TESCP Approved
RW Permit Requited
Street Use Permit Roq'd
Inspection Required
Sidewalk Required
Underground
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STATE LICENSE NUMBER EXPIRATION DATE
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PROPERTY TAX ACCOUNT PARCEL NO.
'51 0 3641010
1:1 NEW RESIDENTIAL PLUMBING / MECH
1 ADDITION COMMERCIAL COMPLIANCE OR
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REPAIR GRADING Cync;
FENCE
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DEMOLISH TANK
OTHER
GARAGE RETAINING WALL
CARPORT ROCKERY
FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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PLAN CHECK NO:
VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
installed on all hot water tanks,
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REMARKS
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SPECIAL INSPECTION rA OCCUPANT'
REQUIRED [] YES LOAD
REMARKS
IPROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINAL INSPECTION REOID z
VALUATION
Description FEE
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Description
State Surcharge
City Surcharge
Base Fee
FEE
Fire Review Plan Chk. Deposit
Fire Inspection Receipt #
Landscapolnsp. Total Amt. Due
Recording Fee Receipt #
APPLICATION APPROVAL
This application Is not a permit until signed by the
CALL Building 011iciplQr his/her Deputy: and F s are paid, and
fOR INSPECTION . rocolqisb�knowleggedinspacavrovided..
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771-0220 RE ASO BY V DAT q
.4�TTXNTION Off 1333
ITI,kONLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADEAND APPROVALOR A CERTIFICATE OF OCCU- ORIGINAL -FILE YELLOW- INSPECTOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. PINK -OWNER GOLD -ASSESSOR
09/03 . PRESS HARD -YOU ARE MAKING 4 COPIES
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT; I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
NAPPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
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
2 FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT [IF
DEEMED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN AN
L Y WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.4
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; TjtAT THE INFORMAIION
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTIiORIZED AGENT OF
THE OWNER.- I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTnUC,
TION; AND IN DOING THE W RK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
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IN VIOLATION OF THE LABO CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSJT4Gk�N FRANCE AND RCW 18,27.
SIG URE (OWNEFIPG
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RECORD OF INSPECTIONS