20000170.pdfPERMIT EXPIRES 9-q-00
DATE RECEIVED
PERMIT 2-oLn -70
CITY OF EDMONDS
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ON THEP BUD
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Y. PERMIT APPLICATION: 180DAYS
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DATE S
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771-0220
EXT 333
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UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
IT IS
HAS BEEN MADE AND APPROVAL OR A CERTIFI-
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GRANTED. USC SECTION 109
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INSPECTOR DATE APPROVED
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THIS PERMIT AUTHORIZES ONLif THE WORK NOTED. THIS PERMIT COVERS WORK TO
t:
.T.oN ON THE PUBLIC
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
T.) WILL FE.UDRE
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS. MARQUEES, FTC.) WILL REQUIRE
ST T. SURCHARGE
STATE SURCHARGE
SEP�RATSfERMISSION..
2
PERMIT APPLICATION: 1130 DAYS
.1
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 160 DAYS
ENO. REVIEW FEES
SSE BACKOF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
DEFEND AND HUD HARMLESS THE CITY OF
EN"NSPECMIN!"I'M
_LA_NDE.WPl_N. __r
IN INTEREST. AGREES TO INDEMNIFY.
2 EDMONDS. WASHIN=ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANYA NO
INSPECTION FEE
ULCLAIMSFORDAMAG OFWHATEVER NATURE. ARISING DIR.—-
A E
NOT BE
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL
DEEMED TO MODIFY. WAIVEOR REDUCE ANY R QUIREMENTOF ANYCITY ORDINANCE
To MD.'
PLAN CHECK DEPOSIT
NOR LIMIT IN ANYWAYTHE CIYY'SABILITY TO ENFORCE ANY ORDINANCE PROVISION.
T IN ANY
I HEREBY THAT: HAVE READ THIS APPLICATION; THAT THE INFORMATION
AND THAT AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
GIVEN IS CORRECT.
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
TION. AND IN DOI;? THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
WASHINGTON RELATING TO
FOR INSPECTION
MACKNOWLEDGS
BoR CODE OF TV STATE OF
IONA MoW�900R AGENT) O�TE s-
(425),
771CD
771-0220
ENTION
EXT 333
UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
IT IS
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
A FINAL
HAS BEEN GRANTED. UBC SECTION 109
FAX
CATE OF OCCUPANCY
5198
PER UBC 1081FINAL
VALUATION I FEE
APPLICATION WPPROVAL
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TUEE� "d
;IALJSIGNATURE� DATE
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ABED By .Al E
ORIGINAL - FIL YELLOW -INSPECT A
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