20000041.pdf-1. RECEIVED
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FPERMIT EXPIRES
USE
CITY OF EDMONDS ZONE
PERMIT
NUMBER 200041
CONSTRUCTION PERMIT APPLICATION JAODBORESS
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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
GRADINGIFILL
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MAROUEES, ETC.) WILL REOUIRE
SEPARATE PERMISSIO 4.
STATE SURCHARGE
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT, 1 YEAR. PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORM ATION
PLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
CITY OF
ENG. INSPECTION FEE
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NPINTEREST, AGREES TO :NDEMNIFY, DEFEND AND HOLD HARMLESS THE
AGENTS FROM ANY AND
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EDMONDS , WASHINGTON i TS OFFICIALS. EMPLOYEES. AND
ALLCLAIMS FOR DAMAGESOF WHATEVER NATURE. ARISING DIRECTLYOR INDIRECTLY
INS
RECEIPT
FR M THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
OEMEO
PLAN CHECK DEPOSIT
DE TO MODIFY. WAIVE OR REDUCE ANY REOUIREMENTOF ANY CITY ORDINANCE
N OR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANYORDINANC E PRDVLSION.'
TOTAL AMOUNT DUE
RECEIPT
THAT] HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
IHEREB ACKNOWLEDGE
OVINER6 H
GIVEN IS CORRECT; AND THAT I AM THE ORT E DULY AUTHORIZE. AGENT OF
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THE OWNE I AGREE TO COMPLY WITH CTYAN STATE LAWS REGULATING CONSTRUC
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CALL
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TION. AND IN GIN THE WORK AUTHORIZED THERE Y. N PERSON WILL BE EMPLOYED
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WASHINGTON RELATING TO
FOR INSPECTION eipj I, ,X,.wi,dgld in spaco prowded
IN VIOLATION OF THE LABOR CODE OF THE STATE OF
.ORK.EWS COMPENSATION INSURANCE AND RCW 16,21.
OFFIC ALS SIGNAYUJE DATE
OR AGE!j ATE SIGTD C
(425)
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�NER
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771-0220
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RE' ASED
EXT 333
ATTEIWION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE YELLOW - INSPECTOR
A FINAL INS ECTION HAS BEEN
P
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK -OWNER GOLD ASSESSOR
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