20050817.pdfDATE RECEIVED 9
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PERMIT
CITY OF EDMONDS NUMBER 0-7 / 7
CONSTRUCTION PERMIT APPLICATION J?DBDRESS
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CITY RW Permit Required 11
ZIP TELEPHONE EXISTING PROPOSED Street Use Permit Required E3
InsPirclion Required 13
Sidewilk Required 13
REQUIRED DEDICATIR� 13
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REMARKS
GEOTECH REPORT
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BY:
VALUATION
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Description FEE Description FEE
Plan Check State Surcharge
VESTED DATE
HEAT SOURCE LOT SLCfPE% _T Building Permit City Surcharge
PLAN CHECK NO:
Plumbing oo Base Fee (Io
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
PERMIT APPLICATION: SEE ECDC 19-00.005(A)(5) Engr. Review
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection
OAPPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND 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 BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapeinsp. Total Amt. Due
NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- 42�5 OC
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION Recording Fee Receipt # a T_1!5,
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVA,
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 hisihor Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING To FOR INSPECTION receipt is acknp%(edged in space provided
WORKMEN'S COMPENS��QNSURANCE AND RCW 18:27,
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SIGN DA Sl ED
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7 771.n,2,2n
RELEAS
WIIENTION EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPT BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 I IBC110 I IRC11O..
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
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Slab Insulation ..........
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INSULATION ...................
Floor Insulation .........
Wall Insulation ............
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Ceiling Insulation .......
SHEETROCK NAILING ...
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SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
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OCCUPANCY .............