20050800.pdfDATE RECEIVED [PERMIT EXPIRES
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITEIAPTIs
ADDRESS
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ROCKERY
DESCRIBE WORK TO BE DONE
NUMBER OF
DWELLING
UNITS
CBLH
DATE I CHECKED BY
ILID
FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPApprayea 13
RvV Permit Required 13
EXISTING PROPOSED
Street Use Permit Required E3
rrispection Requited 13
Sidewalk Required E3
REQUIRED DEDICATION FT
Underground
Waing required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YESO NOM
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REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROS16N CONTROLIDRAINAGE
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REMARKS
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Description
FEE
Description
FEE
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Plan Check
State Surcharge
tit: I �QURCE
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VESTED DATE
Building Permit
City Surcharge,
PLAN CMCK
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Plumbing Base Fee
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Mechanical C) -o
Grading
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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.
Engr. Review
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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
Engr. Inspection
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'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGN S AND SUCCESSORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
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
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
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Recording Fee
Receipt #
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
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"
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE S TE OF WASHINGTON RELATING TO
WORKMEN?:C91f EN 18:27.
,Sf ION)NSURANCE AND R,
CALL
FOR INSPECTION
(425)
APPLICATION AP12ROV—AL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledg id in space provided.
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D#TE SIGNED
771-0220 RELE JY) j
12 LDATE
AfT�NTION 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- ORIGINAL - FILE YELLOW - INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 I IRC110. PINK -OWNER GOLD - ASSESSOR
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