20051131.pdfDATE RECEIVED
PERMIT EXPIRES too
PERMIT
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CONSTRUCTION PERMIT APPLICATION JOB S TF/APT#
ADDRESS
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Description FEE Description FEE
HEATSOURCE LOT SLOPE�. VESTED DATE Plan Check State Surcharge
PLAN CHECK NO: Building Permit City Surcharge
Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THISPERMITCOVE
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Mechanical
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
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LU PERMIT APPLICATION: SEE ECDC 19.00,005(A)(5)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Review Recording Fee
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
*APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Engr. Inspection Plan Chk. Deposit
Lu IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF Fire Review Receipt #
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2 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
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Fire Inspection Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
X01 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
Landscapoinsp. Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APitROVAL
GIVEN IS CORRECT: AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF CALL Thisapplication is not it porinit until signoo ny In(,
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED FOR INSPECTION Building Olfici.ui of his, her Deputy and Fvo' ale p,u(j an(j
IN VIOLATION OF THE LABqBk0DE OF THE STATE OF WASHINGTON RELATING TO % receipt IS a K now1od, od in spaco pr . ovi(i tj
WORKMEN'S COMPENSAT3"SLIRANCE AND RCW 18:27. oFf-1 S -NAlt it )All
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FICATE OF OCCUPANCY HAS BEEN GRANTED. USC1 09 / IBC11 10 / IRC11 10. ORIGINAL - FILE , YELLOW - INSPECTOR
PINK -OWNER - GOLD - ASSESSOR
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