20000103.pdfDATE RECE PERMIT EXPIRES
USE PERMIT
CITY OF EDMONDS ZONE NUMBER 200103
CONSTRUCTION PERMIT APPLICATION IDS _9 / 2 _ _f AFTI
ADDRESS
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VALUATION
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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
DOMAIN (CURBS. SIDEWALKS. DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
GRADING(FILL
STATE SURCHARGE
PERMIT APPLICATION: 180 DAYS
0
PERMIT LIMIT. I YEARI; PROVIDED W RK IS STARTED WITHIN 180 DAYS
P
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SEE BACK 0 ' PINK PERMIT FOR MORE INFORMATION
ENG. REVIEW FEES
;AP LICANT. ON G BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AN SUCCES RS
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IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY F
A FEES To IN�
DMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FRO. ANY AND
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A FOR DAMAGESOF WHATEVER NATURE, ARISING DIRECTLYOR INDIRECTLY
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DEEMED TO MODIFY. WAIVE OR REDU
R N L, 'T Y W Y T. 'S ABILITY TO EN FORCE ANY ORDINANCE PROVISION,'
OR LIMIT IN ANY WAY THE CITY
ENG. INSPECTION FEE
LANDSCAPING
INSPECTION FEE
PLAN CHECK DEPOSIT
TOIL AMOUNT CUE
PIECE
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RECEIPT
I HERE Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVENS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZE 0 AGENT OF
IS C
THEOWNER PADRE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRU
TION, AND IN DOING TEHE WORK AUTH RIZED THEREBY. 10 PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODEDOF THE STATE OF WASHINGTON RELATING TO
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FICI'A NAT
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771 -0220 ERE E.
AYfEN�ION' 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. LEG SECTION 109 FAX
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FINAL APPROVAL FOR
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PERMIT EXPIRES
USE
PERMIT
CITY OF EDMONDS
ZONE
NUMBER
CONSTRUCTION PERMIT APPLICATION
'AOD'DRESS 2,
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11 �IjEl
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11,
110 NO,
PtLAT NAMEISUBDIVISION NO.
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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 (CURDS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIM 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
END, REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. 00 BEHALF OF HIS ON HER SPOUSE, HEIRS, ASSIGNS AND SUCCESOFS
ENG. INSPECTION FEE
IN INTEREST. AGREES TO NCE.NIll DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
EDMONDS. WASHINGTON, 11 S OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
F WHATEVER NATURE. ARISING RECTLY OR INDIRECTLY
CL.AIMS FOR DAMAGESO D'
INSPECTION FEE
IV
RECEZ�
ALL
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERM IT SHALL NOT BE
7-190 - -
PLAN CHECK DEPOSIT
0 Y I OAD
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF AN TY I.D.'.ANC�
-` . E"
0 NOR LIMIT IN ANY WAYTHE CITY'S ABILITY TO ENFORCE ANY ORDINANCC ISION.
TOTAL AMOUNT DUE RECEIPT
IH5REB ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
Y
A.ENTOI
APPLICATION APPROVAL
GIVEN I S CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED
THE OWNER. I AGREE TO COMPLYWITH CITYANDSTATE LAWS REGULATING CONSTRUC
Thl� Ippil-t- 1� P--1
CALL
TION.ANDINDOiNGTHE ORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
--ildged I. so- Fl-d-
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RCLATING TO
FOR INSPECTION
WORK�ENS'YOMPENSATION �SURANCE AND HCW 1827.
FICIALS ON
OWNER OR Aqg�T) DATE SIGNE�
(425)
771-0220
A�TENfION'
EXT 333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
HAS BEEN MADE AND APPROVAL OR A CERTiFl-
ORIGINAL FILE YELLOW - INSPECTOR
A FINAL IN PECTION
S
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK - OWNER GOLD ASSESSOR
FAX