20000001.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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GRADINGIFILL
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STATE SURCHARGE
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT. I YEAR * PROVIDED WORK IS STARTED WITHIN 180 DAYS
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ENG, REVIEW FEES
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OF ANY CITY ORDINANCE
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RECEIPT
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TOTAL AMOUNT DUE
THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
L IC ION APPROVAL
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1 HEREBY ACKNOWLEDGE
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
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PERMIT EXPI IRE
CITY OF EDMONDS
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MECHANICAL
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D T I P C R M IT ER B W 0 K TO
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
TH IS PERMIT AUTH ORIZ E S C
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BE DONS ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
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PERMIT APPLICATION: 180 DAYS
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PERMIT LIMIT. I YEAR � PROVIDED WON S STARTED WITHIN 180 DAYS
ENO. REVIEW FISES
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SEE SA K OF PINK PERMIT FOR MORE INFORMATION
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HER'S ASSIGNS AND BUDDER
'A PUCANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
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ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
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NOT BE
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DEEMED TO MODIFY. WAIVE OR REDUCE ANY R QUIREMENTOF ANYCITY ORDINANCE
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPL CATION: THAT TH E INFORMATION
0 0 IZ . E T C
GIVEN IS CORRE AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
T'
T L W REGULATING ONSTRU
THE OWNER I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC,
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C L
CALL
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TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
RELATING TO
ETC R L T, G To
IFOR INSPECTION
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IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON
WopKMENIS COMPENSATION INSURANCE AND RCW' 18.27�
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771-0220
ATTENTION
EXT 333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED� UBC SECTION 109
FAX
VALUATION I FEE
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ORIGINAL - FILE . YELLOW - INSPECTOR
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