20050770.pdfa
DATE RECEIVED
PERMIT EXPIRES 7)
CITY OF EDMONDS
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PERMIT
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7
JOB SUITEiAP
ADDRESS
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CONSTRUCTION PERMIT APPLICATION
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OWNER NAMEINAME OF BUSINESS
PLAT NAMEISUB DIVISION NO.
LOT NO.
LID NO
LID FEE S
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPApproved
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EXISTING PROPOSED
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Inspeclin Requited
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METER SIZE LINE SIZE
NO. OF FIXTURES PRV REOUIRED
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NUMBER
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NUMBER OF
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REMARKS
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Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE
LOTSLOPE%
VES ED DATE
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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
rig
ILI
916
HE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
U) Fire Review Plan Chk. Deposit
U) @APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESSORS
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-j IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
:E EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
W A-70 j
< 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
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
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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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy and Fees are paid. and
IN VIOLATION OF TVIE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided
WORKMEN'S�:OMPIETAWURANCE AND RCW '18:27.
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DATE JIGNEO 425'
SIGNATURE W I
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L.Q'xu 771-02,
1K. '20 RE DBY DAT
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ATTEN'tION 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. IGINAL IL - YELLOW -INSPEC (OR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 I IBC110 if IRC110- PINK - 0 E - GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIE
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