20000099.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WO.KTO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
REQUIRE
GRADINGIFILL
DOMAIN (CURBS. SIDEWALKS. DRIVEWAYS. MARQUEES, ETC.) WILL
SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN ILU) DAYS
ENS. REVIEW FEE$
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ON BEHALF F HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
CITY OF
ENG. INSPECTION FEE
;APPLICANT
N INTEREST. AGREES TO :NDEMNIFY. DEFEND AND HOLD HARMLESS THE
FROM ANY AND
T5 FICIALS, EMPLOYEES. AND AGENTS
EDVoNDSjWAS",N"To' OF
DIRECTLY ORNDIRECTLY
ALL,,,M F. A.A.E� OF WHATEVER NATURE, ARISING
PERMIT SHALL NOT BE
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DEPOSIT
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OFENTS
OF ANY CITY ORDINANCE
PLAN CHECK
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REOUIREM
PROVISION.'
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
TOTAL AMOUNT DUE I F
HAVE READ THI S AP PLICAT ION. THAT THE IN FORMAT ON
OR THE DUSYRAUTHOGI�ZG- AGENT OF
GIVEN IS CORRECT; AND T , AM THE OWNER,
EE Y WITH CITY AND STAT LAW EGULAT C.NSTUo.
CALL
TI E NE , I G T C
K AUTHORIZED THEREBY. N EPSON WILL BE EMPLOYE
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FOR INSPECTION
IAS BE OF THE STATE WASHINGTON
VI LAT N FTH' R Co OF
WORKMEN S COMPENSATION INSURANCE AND ROW 182�,
(425)
111NAT DATE SIGNED
"ll IlWNll 11
771-0220
EXT 333
ATTENTION/
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
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TO: pERMlIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTM[ENT DATE -
ENGINEERING DIVISION DATE -
PLANNING DIVISION DATE -
OWNER 145� .--------ADDRES
2000,79 A5-11 -7
PERMIT # C
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A field inspection was conducted to determine compliance with approved plans. Final approval
denotes there are no objections to the granting of:
forthe building _____performance Bonds may be released
___-J%4aintenance Bonds may be released _____Landscaping is approved
___�LOthe, inspecte
_f�PASSED FIRST INSPECTION CONDITIONS NOTED
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ING
OUTSTANDING REQUIREMENTS - RECALL
____yAILED INSPECTION 1997
INSPECTION
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REMARKS
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BE DONE ON PRiVAT E N LY.AAN Y CO NOSTEREUSC.TEIO N 0 N I H E P U 8 LiC
EPROP RTYRU
GRADINGIFILL
DOMAI (CU DEWALK 0 VE YSMAR U TO,) WILL REQUIRE
N FES, SI
SE�ARATE PERMISSION.
STATE SURCHARGE
PE RMIT APPLICATION: 180DAYS
PERMIT LIMIT. I YEAR - PROVID DWORK STARTEDWITHIN 180-AYS
LNG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
;AP,P LICANT. ON BEHALF OF HIS 09 HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
DEFEND AND HOLD HARMLESS THE CITY OF
ENG. INSPECTION FEE
C
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N NTEREST. AGREES TO INDEMNIFY,
EDMONDS, WASHINGTON ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
INDIRECTLY
Nqwluw��
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PIS
ALLCI_AI-S FOR DAMA,G6 OFWHATEVER NATURE. A ING DIRECTLYOR
OF THIS PERMIT. ISSUANCE OF THIS PERMIT $HALL NOT BE
PLAN CHECK DEPOSIT
x
0
FROM THE ISSUANCE
DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
RECEIPTf
0
0 ENFORCE ANY ORD
NOR LIMIT IN ANYWAY THE CITY'S ABILITY T INANCE PROVISION."
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
AGENT OF
APPLICATION APPROVAL
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GIVEN RECT. AND T I AM THE OWNER OR THE DULY ALTHO I
IS COR AT LAW
CITY AND STATE S REGULATING CONSTRUC
CALL
."h..t,. - . Y
ty: Foes a,e P.1d.
THE OWN COMPLY WITH
ER. AGREETO
TION,AND,INO IN E WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
0 GTH
OF WASHINGTON RELATING TO
--- INSPECTION
FOR
B,iIT .11d
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d p... p,ovIdad
IN VIOLAT ON 0 F THE LABOR CODE OF THE STATE
WORKMEN'S COMPENSATION INSURANCE AND RCW 18,27�
OFFIC
G TU DATE
DATE SIGNED
(425)
SIGNATURE (OWNER OR AGE NT)
771-022C
EASED By
EXT333
ATTENTIO
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-
ORIGINAL FILE YELLOW INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK -OWNER GOLD ASSESSOR