20060441A.pdfIDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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OERMIT I
NUMBER C�W_
108 SUITEIAPT.
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PILAT NAMEISUBDIVISION NO. LOT 10, "D 0
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VALUATION
VALUATION
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Description
FEE
Description
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FEE
LOT SLOPE'. VESTED DATE
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Building Permit
City Surcharge
1510()
PLAN CHECK NO:
Ic'umong
Base Fee
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THIS PERMIT AUTHORIZES ONLY THEWORK NOTED, THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPER ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN ICUR... SIDEWALKS. CRIVE.S. ARDUEEs, ETC.1 WILL RECIUIRE
: PARATE PERMISSION,
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Mechanical
Grading
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PERMIT APPLICATIONi SEE ECDC 19.00.001(A)IS)
PERMIT LIMIT. SEE ECDC 19.00.005(A)(6)
Engr. Review
Recording Fee
Enqr. Inspection
Plan Chk. Deposit
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
IN INTEREST, AGREES TO It DEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEE% AND AGENTS FROM ANY AND
AL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY 08 INDIRECTLY
L
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SMALL NOT BE
DEEMED TO MODIFY. WAIVE OR REDUCE ANY PEOUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITWS ABILITY TO ENFORCE ANY ORDINANCE PROVISION,
I'. Review
Receipt
Fire Inspection
Total Amt. Due
Landscape Insp.
Receipt #
"I-1-41S
t HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION CALL APPLICATION APPROVAL
GIVEN IS COIRRECT; Ali. THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF Tn's 11PP1.11111-1nolop"'A Int"KKInny In.
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CO"STRUC- nd F..F .1. pl
T*N� AN. IN DOING THE ...a AILIT ... IZ�. T ..... I No PERSON VBLL .. FOR INSPECTION ""I O'c"
EMP DYED P,
IN ffiVIOLATION 01 THE LAB R CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND FEW 18:27. (425)
771-0220
ao� 7;7;A6. EXT. 1333
EINTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APP ROVAL OR A CERTI- ORIGINAL FILE YELLOW INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110. PINK - OWNER GOLD - ASSESSOR
6105 PRESS HARD - YOU ARE MAKING 4 COPIES
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