20051039A.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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REMARKS
OWNERiCONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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REMARKS-
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STRUCTURAL DESIGN
BY -
VALUATION
Description
FEE
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FEE
Plan Check
State Surcharge
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HEAT SOU FICE
LOT SLOPE
VESTED DATE
Building Permit
City Surcharge
CHECK NO:
Plumbing
Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO.
Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
Grading
SEPARATE PERMISSION.
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PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
Engr. Review
Recording Fee
PERMIT LIMIT., SEE ECDC 19.00.005(A)(6)
Engr. Inspection
Plan Chk. Deposit
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
OF
Fire Review
Receipt #
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i IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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4 ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Fire Inspection
Total Amt. Due
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
0 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.0
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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 CALL This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- FOR INSPECTION Building Official or N51her Deputy- and Fees are paid, ano
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED receipt i acknowledged in space provided
IN VIOLATION OF THE L480RCODE OF THE STATE OF WASHINGTON RELATING TO I
WORKMEN'S COMPENSATION IN RANCE AND RCW 18:27. OFFjN9TIGNtU)E DATE
0 (425)
AGE DATE SIGNE
SIGNATJE�� E RO 771-0220 __�rf_EASE DATE,'
61�11"Iiigd 4'ie?Z 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- ORIGINAL - FILE - YELLOW - INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110. PINK - OWNER - GOLD - ASSESSOR
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