20050864.pdfFDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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ENGINEEROG R&ffGKtIST ON BACK OF JOB. eAhD
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STRUCTURAL DESIGN
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VALUATIOIii
VALUATION
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Description.
FEE
Description
FEE
Plan Check
State Surcharge
VESTED DATE
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City Surcharge
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
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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)
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
Fire Review
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Landscape Insp.
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DWEEMED 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.'
Recording Fee
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 REGUL ING CONSTRUC. CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE95.,,THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEh" COMPENSATION INSUR-AgCE #ND RCW 18:27.
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(425)
771 -0220
ATT)EOTION EX L I;JJJ
IT IS LWAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110.
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt#
APPLICATION APPiR-0-VAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid. and
1�. receipt is acknowledged in space provided.
RELEASED
10/04 PRESS HARD - YOU ARE MAKING 4 COPIES
�IGMAL -FILE YELLOW -INSPECTOR
PINK -OWNER GOLD - ASSESSOR
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A field inspection was conducted to det rmme compliance with -approved plans. Final appioval
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denotes that there are no objections from the -above signed Department to the release of
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PERFORMANCE BONDS and the granting of
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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El Copy of CONDITIONS given to owner/contra6tor by inspector.
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FAfLED FINAL INSPECTION - OUTSTANDING ISSUES
[1. Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
bate Signature
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