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STATE LICENSE NUMBER EXPIRATION DATEREQTI COMPLETED F.%EMPT
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1:1 NEW ❑ RESIDENTIAL ❑ PLUMBING I MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR
COMMERCIAL COMPLIANCE OR
❑ ADDITION MIXED USE 13CHANGE OF USE
❑ PARKING LOT AREA PLANNING REVIEWED BY DATE
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GARAGE _ ❑ CARPORT ❑ ROCKERY RETAINING WALL FIRE ❑ FIREA ARM LER
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TYPE OF NSTRUCTION CODE GROUP
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OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
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State Surcharge
HEAT SO RCE LOT SLOPE% VESTED DATE
as Building Permit City Surcharge
1 2:76
LAN CHECK N • h / Plumbing Base Fee
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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
W PERMIT APPLICATION: SEE ECDC 19,00.005(A)(5)
4 PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
*APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit s 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 # 7 3L
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE f
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due �j L
= NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee Receipt # ea7l
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR 7 DULY AUTHORIZED AGENT OF This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AN OR
REGULATING CONSTRUC• CALL Building Official or his/her Deputy: and Fees are paid, and
TION; AND IN DOING THE RK AUTHOR D E , NO PERSON WILL BE EMPLOYED receipt is acknowledged in space provided.
IN VIOLATION OF THE OR C DE I $ /1 E OF WASHINGTON RELATING TO FOR INSPECTION
Wopp COMPE O N E CVy 18:27, OFF LS I ATURE DATE
SIG ATURE G 00f DAT IGf (425) S •rj-'
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T NTION EXT. 1333 \ AALklo,
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI IGINAL . FIL YELLOW -INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1091 IBC1101 IRC110. PINK OWNI GOLD - ASSESSOR
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