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Description FEE Description FEE
V6 610. h State Surcharge
PLAI, Plan Check
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HEAT SOURCE I LOTSLOPE%f ESTED DATE Building Permit City Surcharge
PLAN 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 PUBIC Grading
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
LU PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT* SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
(n 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
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-i IN INTEREST, AGREES� TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
X EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOP DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapelnsp. Total Amt. Due
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.�
Recording Fee Receipt ft
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAC
GIVEN IS CORRECT; AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC. CALL Building Official or his/her Deputy, and Foes are paid. and
TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED receipt is acknowledged in space provided
IN VIOLATION OF THE LABQL8 CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
'S COMPENSAYQt�,IRS�RANCE AND RCW 18:27. M.FICIALS SIGNA D TE
WNER 01 AGENiy (425)
Sl ATURE I DATE SIGNED
DATE
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ATTENTION EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
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INSPECTOR DATE APPROVED
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Gas Test ....................
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Equipment ....... .......
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EXTERIQ'A SHEATHING
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NAILING ..........................
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FRAMING ........ ................
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INSULATION ...................
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Floor Insulation .........
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Wall Insulation ...........
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Ceiling Insulation .......
SHEETROCK NAILING...
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SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ...................