20050882.pdfDATE RECEIVED
PERMIT EXPIRES
/PERMIT
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT0
ADDRESS
OWNER NAMEINAME OF BUSINESS
PLAF NAM DIVISION NO LOT NO, LID NO
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Sidewalk R"wrea 13
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NAME I ER SIZE LINE SIZE NO. OF FIXTURES I PRV REQUIRED
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Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE LOTSLOPE% VESTED DATE Building Permit City Surcharge
CIl 1011i
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 Grading
9 DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
71 Engr. Review
a: PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
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0. PERMIT LIMIT. SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) S Fire Review Plan Chk. Deposit
in 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSOR
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_1 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 #
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ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
RDINANCE Landscapelnsp. Total Amt. Due
_j DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY 0
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISIOI
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 This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC_ CALL Building Official or hislhor Deputy: and Fees are paid. and
TION; AAND IN D011 THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIORATION OqjTH ABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided
WORKMEN'S fpMFf NIALTION INSURANCE AND RCW 18:27. IC SIGNATUR DA E
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SIGNIE AGEII DATE SIGNED (425) ell,
A
771-0220 R -DBY
ATTENTION EXT.11333
IT IS UNLAWFUL TO USE OR OCCUPYA BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
7 ORI PINAL -FILE t-LOW -INSPECTOR
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FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1091 IBC110 / IRC110. (it K -OWNER - GOLD - ASSESSOR
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FINAL PROJEcr APPROVAL FORM
TO,: —
DATE:
"MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
"FROM: FIRE DEPARTMENT DATE
PLEASE SIGN
4.,ENGINEERING DIVISION DATE
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES.
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RE71NSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:teMp:b1dg:f6nns:ocaprv1 3/25/04
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