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DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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Description
FEE
Description
FEE
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Plan Check
State Surcharge
HE AT SOURCE
LOTSLOPE%
VESTED DATE
uilding Permit
B j I I g Pe TETI it
City Surcharge
PLAN CHECK NO:
Plumbing
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
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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
En9r. Inspection
0 *APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
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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 til
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE 17- ---
E Landscape Insp Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANC
01 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION
Recording Fee Receipt ifil
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAI I AM THE OWNER, OR THE OULY AUTHORIZED AGENT OF I Pi's .1 pillic'11101) 1% 1101.0 pliffnil will, hitined Oy tht.
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULAIIING CONSTRUC- CALL jikj+bn�j OfficiAl Of 11.0;of Dtivuly and Fu0sWeLl'I'll 'Irld
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED foce'111 kS'1ci,f1(Wmj(j(j0
IN VIOLATION OF THE LA09B CODE OF THE STATE OF WASHINGTON RELATING TO FOR IN SPECTION
WORKMEN'S COMPENSAT "CW 111:27.
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IT IS UNLAWFUL TO USE OR Od A BUILDING OR STRUCTURE UNTIL I
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- OWGINA1 -FILE - YELLOW INSPECIOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1091 IBC110 ( IRC110. PINK - OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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