20051032.pdfDATE RECEIVED "IA
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PERMIT EXPIRES
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REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLJDRAINAGE
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GEOTECH REPORT
BY:
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STRUCTURAL DESIGN
BY -
VALUATION
Description
Plan.Check
HEATSOURCE
LOT SLOPE%
VESTED DATE
Building Permit
PLAN CHEC K NO:
Plumbing
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Mechanical
Grading
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
Engr. Review
Engr. Inspection
'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
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
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Fire Review
Fire Inspection
Landscapelnsp,
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 ANDSTATE LAWS REGULATING CONSTRUC-
TION; AND IN#QING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATIO111 AF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S Rpli� SATION INSURANCE AND RCW 18:27.
CALL
FOR INSPECTION
(425)
SIGVTURf,VwN" �R AGENT): __ ___ -1
DATE SIGNED
L 771 -0220
EXT. 1333
ATTENTION
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 / IRC11.0.
OCCUPANT
GROUP
FEE Description
State Surcharge
City Surcharge
Base Fee
FEE
Recording Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt # r
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APPLICATION APPROVAL
This application is not a permit until signed by trio
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in Space provided
F IALS TSI'NATU E DPTE
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ORIGINAL - FILE YELLOW - INSPECTOR
PINK -OWNER GOLD - ASSESSOR
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