20050749.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ER NAME NAME OF BUSINESS
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PLAT NAMEISUEDWISION NO.
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Description
FEE
Description
FEE
Plan Check
State Surcharge
T__HEArS6URCE —r--IOTSLOPE-A VESTED DATE
Building Permit
City Surcharge
PLAN CHECK NO:
Plumbing
Base Fee
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M.chanical
THI PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Grading
BE DONE ON PRIVATE PROPERTY ONLY� ANY CONSTRUCTION ON THE PUBIC
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SONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) LL REQUIRE
EPARATEPERMISSIOW_
Engr. Review
PERMTTAPPLICATION: SEE ECDC 19.00,005(A)(5I
Engr. Inspection
LIMIY� SEE ECOC 19,00,005(A)t6l
SEE a PERMIT 'a,
ACK OF PINK PERMIT FOR MORE INFORMAT
Fire Review
PlanChk.Deposit
'APPLICANT, ON BEHALF OF His OR HER SPOUSE, HEIRS� ASSIGNS AND SUCCESSORS
SS HE CITY OF
IN INTEREST, AGREES To INDEMNIFY. DEFEND AND HOLD HARMLESS
S MONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM A Y AND
ED
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT a'�
OF CITY
L.ndscapeinsp.
Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT ANY OREINAH
NOR LIMIT IN ANY WAY THE CITY*S ABILITY TO ENFORCE ANY ORDINANCE PROVISION
i, Receipt # 3
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLI ATION APPROVAL
GIVEN IS CORRECT�, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
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THE OWNER. I AGREE To COMPLY WITH CITY AND STATE S REGULATING CONSTRUC-
CALL
TION; AND IN DOING TH WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYrED
THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
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IN VIOLATION OF
WORKMEN'S COMPENSATIOMFANCE AND FCW 1 :27.
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SIGNATURE DA ESIGNEO
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771-0220 `RELEASED BY OATE .
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ATTENTION
EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
OR.
FICATE OF OCCUPANCY HAS BEEN GRANTED, USC109 / IBC110 I IRC110.
PINK OWNER - GOLD - ASSESSOR
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