20051137.pdfDATE RECEIVED [PERMIT EXPIRES
PERMIT
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITE�APT#
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Description
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Plan Check
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Building Permit
PLAN CHECK NO:
Plumbing
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. 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
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PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Review
Engr. Inspection
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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
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIREC TLY OR INDIRECTLY
FRO HE 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
Landscapeinsp.
0 00 A n YUIQ A 001 IPATION THAT THE INFORMATION
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CON . SuLTANT I OLOCA8 PANT
I HEREBY ACKNOWLEDGE THAT I HAV 9
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF CALL
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
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENS���ANCE AND RCW 18:27.
(425)
RE (OWNIER)�AGE )Y: DA SIGNEP 771-0220
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FEE Description
State Surcharge
City Surcharge
Base Fee
FEE
Recording Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due
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APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his1her Deputy- and Fees are paid, and
fr�, receipt is acknowledged in space provided
RELEASED
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AtTtNTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OFoCCUPANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
6/05 PRESS . HARD - YOU ARE MAKING 4 COPIES
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