20051065.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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Description
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Plan Check
State Surcharge
HEAT SOURCE
LOT SLOPE96.
77ESTED DATE
Building Permit
City Surcharge
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PLAN CHECK N 0-
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
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: SEE ECDC 19,00.005(A)(5)
Engr. Review
Recording Fee
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PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
Engr. Inspection
Plan Chk. Deposit
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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*APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
Fire Review
Receipt #
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EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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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
oil DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
ABILITY TO ENFORCE ANY ORDINANCE PROVISION.@
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Receipt #
0 NOR LIMIT IN ANY WAY THE CITY's
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1 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- Building 011icial or hig/her Deputy and Fees are paid. and
FOR INSPECTION
TION; AND IN DOING THE WOPA.6UTHO ZED THEREBY, NO PERSON WILL BE EMPLOYED receipt is ackno Wedged in space provided
IN VIOLATION OF THE LAqAR-zWE OF THE STATE OF WASHINGTON RELATING TO
DATE
,;Pf6N INSORIA�CE AND FICW 18:27. OF; F 177 S
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SIGN URE E R 0 k A G E N T�):��/ DATE
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ZIGNED,
RELE ifY DA E
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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