20050881 (2).pdfy DATE RECEIVEDF—�
PERMIT EXPIRES
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CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB ADDRESS ! 1 4%SUITE/APTN
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PLAT NAMEISUBDIVISION NO. LOT LID NO.
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ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR
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❑ COMMERCIAL COMPLIANCE OR ?
ADDITION ❑ MIXED USE ❑ CHANGE OF USE i
PARKING LOTAREA PLANNING REVIEWED BY DATE g
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REQ'D PROVIDED
❑ REPAIR ❑ GRADING CYDS ❑ FE14CE
( X FT.) REMARKS
❑ DEMOLISH ❑ TANK OTHER
GARAGE z ❑ CARPORT ❑ RETAINING FIRE LER
ROCKE YWALL ❑ FIREALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) PLAIN:
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GROUP
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OF DWELLING SPECIAL' INSPECTION CONSULTANT OCCUPANT
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STRUCTURAL DESIGN
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Description FEE Description FEE
Plan Check Slate.Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE
Building Permit City Surcharge
PLAN CHEC O: Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO MBChanIC21
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL, REQUIRE Grading
t SEPARATE PERMISSION.
s Engr. Review
w PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
Is. PERMIT LIMIT: SEE ECDC 19.00,005(A)(6) Engr. Inspection
BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, 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
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
Q 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
C DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due
i NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION,*
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 p the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or acknowledged
Deputy: and Foos are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space pr vided.
WORKMEN' 5ATION INSURANCE AND RCW 18:27.
SI URE DAT
SIG T E (OWNE AG T): DATE SIGNED/} (425) L
of
r 771 - 1
0220 RELEAS D B DATE
ATTENTION IEXT. 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 rr IBC110 I IRC110, PINK -OWNER GOLD - ASSESSOR
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