20051138.pdfDATE RECEIVED
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CITY OF EPMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SSL/? SUITE/APTx
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MIXED USE CHANGE OF USE LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIFISIDE REAR
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GEOTECH REPORT
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Plumbing Base Fee
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Mechanical
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
Grading
t: SEPARATE PERMISSION.
M PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
W Engr. Review Recording Fee
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
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
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Fire Inspection Total Amt. Due
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE L
a ODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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C NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION., Landscapelnsp. Receipt #
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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 not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- Building Official or his/her Deputy, and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED FOR INSPECTION receipt iKknowled ed in space provided
IN VIOLATION OF TU.ILABOR CODE OF THE STATE OF WASHINGTON RELATING TO IN -
WORKMEN'S COMPE6>�"]�SIURANCE AND RCW 18:27. (425) OFFI S N U)E DATE
I YAE (OWNER AGL DAT 20
SIGNA
771-02
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I /;�_ �C i I I RELEASE Y, ATE
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AITtNTION --------------
IT IS UNLAWFUL TO USE OR O(xUPY A tsuilwiNLj OR ST RUCTUREE UIN 1 lL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL - FILE YELLOW - INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1091 IBC110 I IRC110. PINK -OWNER - GOLD - ASSESSOR
6/05 PRESS HARD - YOU ARE MAKING 4 COPIES
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