20050974.pdfDATE
CITY OF EDMONDS
CONSTRUCTION. PERMIT APPLICATION
ER NAME/NIAMEOF BUSINESS.
MAILING ADDRESS
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NAME
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PERMIT EXPIRES
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NUMBER
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PLAT NAME/SUBDIVISION NO,
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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Street Use Prifund Required
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EXISTING PROPOSED
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METER SIZE LINE SIZE
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COMPLIANCE OR
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6 POSED SEIBACKS (FT.)
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ALLOWED PROPOSED FRONT S '""ReAR
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MULTIFAMILY
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( X FT.)
REMARKS
TANK
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FIRE SPRINKLER
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FIRE ALARM
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NUMBER OF
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REMARKS
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VALUATION
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Description FEE
Plan Check
HEAT
L T�LOPE /to
VESTED DATE
PLAN CHECK NO:
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
9
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
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PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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4
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r'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
I
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
D M C E
EEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANC
IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
OR LIMIT
N OR LIh
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-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENS ?10T_,_VU NCEANDRCW18:27.
SIGNAVI�(OWNER OFW(GEI/I
DATE SIGNED
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapeinsp.
Recording Fee I
CALL
FOR INSPECTION
C
.(425)
771-0220
Description FEE
State Surcharge
City Surcharge
Base Fee _I�ID
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 Foes are paid. and
receipt is acknowledged in space provided
FICIALS SIPj\TURE A DATf
AfTgNTION e�/ — .
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. UBC1109 if IBC1110 / IRC110- PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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