20000212.pdfDATE RECEIVED �RMIT EXPIRES
USE PERMIT
CITY OF EDMONDS ZONE NUMBER "J
1 6 SU"I"a;T.
CONSTRUCTION PERMIT APPLICATION ADDRESS
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T�,S PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
LI
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
9
It
WAY
DOMAIN (CURBS. SIDEWALKS, DRIVE S. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
STATE SURCHARGE
PE MIT APPLICATIOM, 180 DAYS
PERMIT LIMIT. 1 YEAR . PROVIDED WORK S STARTED WITHIN 160 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
AND SU ES RS
-APPLICANT, ON BEHALF OF HIS On HER SPOUSE. HEIIIS, ASSIGNS HE ITY F
HOLD HARMLESS
ENG. INSPECTION FEE
IN INTIOEST.=.1T.'NO NDE.NIlY. DEFEND AND
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ALLCLAIMS FOR DAMAGESOFWHATE ER NATURE, ARISING
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FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THI PERMIT SHALL NOT
ANY CITY ORDINANCE
PLAN CHECK DEPOSIT
DEEMEDTO MODIFY, WAIVE OR R50UCE ANY REQUIREMENT OF
CITY'SABILITY TO ENFORCE ANY ORDINANCE PROVISIONL'
0 NOR LIMIT IN ANYWAYTHE
TOTAL AMOUNT DU
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INF RMATION
AGENT OF
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED
I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
THE OWNER.
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
RELATING TO
FOR INSPECTIII
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON
WORKMEN'S COMPENSATK�jq INSURANCE AND RCW 16.27.
E A _t kTE SIGNED
(425)
3--/3--co
771-0220
EXT 333
��ENTION
IT Ift"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
CODE
C�IJA
1081FINAL
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INSPECTOR DATE APPROVED
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EXTERIOR SHEATHING
NAILING ........... ..............
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SPECIAL INSPECTION
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FINALAPPROVAL FOR
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OCCUPANCY ..................
ATE RECEIVED
PERmIT 2011
ZONE
CITY OFEDMONDS
ER
NUMtBER
CONSTRUCTION PERMIT APPLICATION
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OWNER NAMEINA
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FLAT NAMEISUBDIVISION NO. LOT NO. LI.
LID FEE S
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CITY
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ADDRESS
REMARKS
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MECHANICAL
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CONSTRUCTION ON THE PUBLIC
BE DONE ON PRIVATE PROPERTY ONLY. ANY
DOMAIN (CURS$, SIDEWALKS, DRIVEWAY , MARQUEES, ETC�) WILL REQUIRE
GRADINGIFILI.
SEPARATE PERStI
L
STATE SURCHARGE
PERMIT APPLICATIO ! 180DAYS
A, FERMtrLjMII i YEAR. PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INF DRMATION
------------- —
71-7'-
'APPLICANT ON BEHALF 0 HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
AGREES TO EMNIFY I DEFEND AND HOLD HARMLESS THE CITY OF
IN :NO
ENG. INSPECTION FEE
L*.9sem""r 6,fn _2S�-Gb
HgERES'T, ENTS FROM ANY AND
N TSOF1ICIALS,E.PLO1EES,ANDA.
ED. D., YASN'N.T. ,
ALC_,M"ODAM AD S OFWHATEVER NATURE, ARISING DIRECTLIOR INDIRECTLY
OF THIS PERMIT SHALL NOT BE
INSPECTION FEE
DEPOSIT
FROM TN�SSUANCE OF THIS PERMIT. ISSUANCE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENTOF ANY CITY ORDINANCE
ANY ORDINANCE PROVISION.-
PLAN CHECK
RECEIPT
5 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE
TOTAL AMOUNT DUE
5p,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS COFF�- AND THAT � A. THE OWN�.. 0. THE ULY AUTHORIZE D AGENT OF
APPLICATION li
I
/bALL
THE OWNER. I AGREE TO COMA AND STATE LAWS REGULATIN CONSTRUC-
WITH CITY G
0 ING THE WORKLAYUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
.,.,hd. -d
TION:AND,tNO RELATING TO
IN WOLAT ON OF THE LABOR CODE OF THE STATE OF WASHINGTON
FOd INSPECTION
E
WORKMEN'S COMPENSATION INSURANCE AND RCW 1 Sz7.
OFFICIALS SIGNATURE 3. D
(425)
SIGNATURE I NE A ENT) D E SIGNED
771-0220 RELEAS 0 E
EXT 333,
ENTION
USE OR OCCUPY ABUILDINGPOR STRUCTURE UNTIL
771-0221
IT IS UNLAWFULTO
FINAL INSPECTION HAS BEEN MADE AND AP ROVAL OR A CERTIFI- ORIGINAL FILE YELLOW, IN PECTOR
ASSESSOR
A
CATE OF OCCUPANCY HAS BEEN GRANTED, UBG SECTION 109
5,98
FAX PINK - OWNER GOLD -