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I "ERF.BY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
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GIVEN IS CORRECT, AND THAT I AM THI'ECDVVNEN� OTATT�IIE OUL`RAUTH
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ATJtNTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
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CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
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FPERMIT EXPIRES
CITY OF EDMONDS
usbe PERMIT
ZON NUMBER 200121
CONSTRUCTION PERMIT APPLICATION
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PERMIT APPLICATIOA: lisdak,
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TIO�
ENG. REVI�W FEES
SEE BACK OF PINK PERMIT FOR MOIRII�INFOII,
TIONFEE
-APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS. A
IN INTE EST, AGREES TO;NDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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A LAIMS FOR DAMAGSSOFWHATEVER NATURE�
INSPECTION
RECEIPT
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY IECIIIREMENT.F ANY CITY ORDINANCE
PLAN CHECK DEPOSIT
0' NOR LIMIT IN ANY WAY THECITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
IRECEIPTf
TOTAL AMOUNT DUE
q
I HERE Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION,
8
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GIVEN CORREC T.� AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
IS
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THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONST RUC.
WILL BE EMPLOYED
CALL
Bos ,,l
TION AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON
C008 OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
FOR
IN VIOLATION OF THE LABOR
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.21.
_
OFFICI
Sj::;��R OR AGENTb,
DATES' NED
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(425)
4? 2
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RELEASE
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ATttNTION
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IT IS UNLAWFUL TO USE 08 OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL IftPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. LED SECTION 106
FAX
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PPLICATION APPROVAL
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ORIGINAL - FILE - YELL. - INSPECTOR
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