20050762.pdfPERMIT EXPIRES 'i� IOU)
DATE RECEIVED
CITY OF EDMONDS
PERMIT '7(()
NUMBER "Z4,j
CONSTRUCTION PERMIT APPLICATION
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Description
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Building Permit
City Surcharge
PLAN CHECK NO:
Plumbing
Base Fee
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
SEPARATE PERMISSION.
Engr. Review
W PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
Engr. Inspection
CL PERMIT LIMIT: SEE ECDC 1I9.00.005(A)(6)
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
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.j IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT; ISSUANCE OF THIS PERMIT SHALL NOT BE
a DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
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Recording Fee
Receipt #
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
This application is not a pernia until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK ALIT IORIZED THEREBY. NO PERSON WILL BE EMPLOYED
CALL
Building Official or his/her Deputy: and Fees are paid, and
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IN VIOLATION OF THE LABOR Co E 0 F THf- STATE OF WASHINGTON RELATING TO
FOR INSPECTION receipt is acknowledged in space provided
WORKME ENSATION INSU)JAINCE A)iI5RCW 18:2
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SP<A-T-1I1RE�&ER ENT, DATE S!ANED
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IT IS UNLAWFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
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FINAL PROJECT APPROVAL FORM
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Date Signature
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ENGINEERING INPSECTION
FEE RECONCILIATION
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Project Name:
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Contac t: JD. K
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Contact notified of fees due: El by phone. El correction notice given..
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REFUND Due.-
4/117/
Reconciled By: Date
Original to: Permit File Copy to: �(Engineering Admin (refunds only)
Revised 3/2/06