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PERMIT EXPIRES
PERMIT
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITEiAPT#
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PLAT NAIAE�SIJBDIVISION NO. LOT NO. LID NO,
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NUMBER NUMBER OF
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Description FEE Description, FEE
SOURCE LOT SLOPE96 VESTED DATE Plan Check State Surcharge
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0 S I . I Building Permit City Surcharge
PLAN CHECK NO: . I e)
Plumbing Base Fee
(7-U —_ L)
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Mechanical
9 DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
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I= SEPARATE PERMISSION. Grading.
M 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)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection Plan Chk. Deposit
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
W IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF Fire Review Receipt #
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:E EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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
_j NOR LIMIT IN AN __ [Receipt #
0 Y WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' Landscapelnsp. s�2 7<7q q
I 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 nola perinit until Signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- Building Otficial or hisiher Deputy and Fees are paid. ano
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED FOR INSPECTION receipt Kknowledged in space provided
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATIQUt�TUFIANCE AND RCW 18:27. 3N TU DATE
(425)
[:SIG URE(ow P= DATE SIGNED
771-0220
EXT. 1333 RELEAT By DATE
AT TION
IT 15UNLAWFUL TO USE OR/OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPF-UTIUN mAS BEEN MADE AND APPROvAL OR A CrEn I I- ORIGINAL - FILE YELLOW - INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 if IBC110 / IRC110- PINK -OWNER GOLD ASSESSOR
6/05 PRESS HARD YOU ARE MAKING 4 COPIES
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