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Description EE Description
........... Plan Check State Surcharge
. . . . ........ VESTED DATE
HE FSOURCE LOT SLOF1::;1D Building Permit City Surcharge
PLAN ',HECK NO: plumbing Base Fee
ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
THIS PERMIT AUTHORIZES
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS. SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION. Recording Fee
PERMIT APPLICATION: SEE ECDC 19-00-005(A)(5) Engr, Review
PERMIT LIMIT'. SEE ECDC 19.00.005(A)(6) Plan Chk. Deposit
SEE BACK OF PINK PERMIT FOR MORE INFORMATI . ON Engr. Inspection
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESSORS Receipt III
I INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF Fire Review
IN s, EMPLOYEES, AND AGENTS FROM ANY AND Total Amt. Due
EDMONDS, WASHINGTON. ITS OFFICIAL
IIAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY Fire Inspection
ALL CLAIMS FOR DAN E OF THIS PERMIT. ISSUANCE OF THI.S PERMIT SHALL NOT BE
FROM THE ISSUANC WAIVE OR REDUCE ANY REQUIREMEN1 OF ANY CITY ORDINANCE Receipt 61
DEEMED TO MODIFY, 'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- Landscapeinsp.
NOR LIMIT IN ANY WAY THE CITY APPLICATION APPROV
by I
I- THAT THE INFORMATION until signed by 1 0
'E THAT I HAVE READ THIS APPLICATION. This application is not a permit
I HEREBY ACKNOWLEDC, THE OWNER, OR THE DULY AUTHORIZED AGENT OF CALL Buitding official or his1her Deputy and Fees are paid. and
--N IS CORRECT; AND THAT I AM :GULATING CONSTRUC- N I
GIVE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS HE )N WILL BE EMPLOYED FOR INSPECTIO receipt Isagknowledr d In space provided
THE HEREBY, NO PEASC
TION- AND IN DOING THE WORK AUTHORIZED T N RELATING TO
IN VI'OLATION OF THE LAB CODE OF THE STATE OF WASHINGTO (425) -F IA IGNAI R
WORKMEN'S COMP SAT' Sun CE AND RCW 18:27.
PF DATE SIGNED 771-0220 RELE F0 B DATE
SIG // I# EXT. 1333
ATTED14 IuPf OR OCCUPY A BUILDING OR STRUCTURE UNTIL FILE YELLOW - INSPECTOR
IT IS UNLAWFUL TO USE A CERTI- ORIGINAL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR PINK -OWNER GOLD ASSESSOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110.
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