20050917.pdfI
FDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEiNAME OF BUSINESS
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MAILING ADDRESS
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NAME
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PLAT NAME/SU BDIVI SION NO.
LOT NO
LID NO.
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LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved 13
13
RW Permit Required
0
Street use Permit Required
EXISTING - PROPOSED
inspection Required E3
Sidewalk Required 13
13
REQUIRED DEDICATION FT
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REMARKS
DEMOLISH TANK
OTHER
GARAGE o RETAINING WALL
FIRE SPRINKLER
CARPORT
ROCKERY
FIREALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN
NUMBER __TN BEIR OF
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REQUIRED 13YES
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DESCRIBE WORK TO BE DONE
REMARKS
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Building Permit
PLAN CHECK NO: Plumbing
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.Q05(A)(5) Engr. Review
PERMIT LIMIT. SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PER MIT FOR MORE INFORMATION
'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
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection
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 Landscape Insp.
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee I
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- CALL
TION; AND IN DOING THE RXd HORIZED THEREBY, NO PERSON WILL BE EMPLOYED
,� �JJE OF THE
IN VIOLATION OF TMHEB IR C STATE OF WASHINGTON RELATING TO FOR INSPECTION
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WORKMEN'S COMP N INSUqNCE AND RCW 18:27.
SIGNAVRE (OWNE E DATE S19NED (425)
771-0220
/7 =P1 /-z. � I
ATTENTION e5/ 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-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110.
OCCUPANT
GROUP
OCCUPANT
LOAD ,
Description
State Surcharge
City Surcharge
Base Fee.
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is ��knovvleclgjd in space provided.
CIA7GNA VUR, DATE
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