20051116.pdfDATE RECEIVED
CITY OF EbMONDS
CONSTRUCTION PERMIT APPLICATION
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W4911116111
Description
Plan Check
H AT SOURCE
LOT SLOPE'.
VESTED DATE
Building Permit
PLAN CHEOC NO:
Plumbing
THIS PERMIT AUTHORIZES ONLY THE 7WORK7OTED. 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 10.00.005(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 W14ATEVER 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
Landscape Insp,
I HEREBY ACKNOWLEDGE THAT I 14AVE READ THIS APPLICATION, THAT THE INFOnMATIOJN
GIVEN IS CORRECT: AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF CALL
THE OWNER. I AGREE 10 COMPLY WITH CITY AND STATE LAWS REGULATING CONSTAUC-
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TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYFO FOR INSPECTION
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
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CONSUL
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FEE Description
State Surcharge
City Surcharge
0,1 Base Fee
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Recording Fee
Plan Chk. Deposit
Receipt #
Total Amt. Duo
Receipt
APPLICATION APPROVAL
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- C
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 I IBC110 / IRC110.
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