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DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMITAPPLICATION
OWNER NAME/NAME OF BUSINESS
PERMIT
NUMBER
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ADORES
PERMIT EXPIRES
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CITY ZIP,
TELEPHONE
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REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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Description
FEE
Description
FEE
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Building Permit
City Surcharge
PLAN CHECK NO:
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Plumbing
Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOT& THIS PERMIT COVERS WORK TO
Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Grading
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
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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 TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
Fire Review
Receipt #
_j IN INTEREST, AGREES
M EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
cc ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
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Fire Inspection
Total Amt. Due
FROM THE 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.*
LandscapeInsp.
Receipt #
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-
FOR INSPECTION
Building Official or his/her Deputy, and Fees ate 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 LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
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WORKMEN'S COMPENSAT��ANCE AND RCW 18:27.
OI(Fld,IAAI q S N E DATE
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NATURE (OWNER o AGENT):'
DATE SIGNED
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RE EASED BY 6A�K
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A FINAL INSPE ION HAS BEEN MADE AND APPROVAL OR A CERTI-
ORIGINAL -FILE - YELLOW -INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1 09 / IBC11 10 / IRC1 10.
PINK -OWNER - GOLD - ASSESSOR
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MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
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A field inspection was conducted to determine compliance with -approved plans. Final. approval
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AILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner./contractor by inpec.tor
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
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