20000230.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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US PERMIT
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RECEIPT
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FROM TH EU HCE OF TH ISSUANCE OF THIS PERMIT
ANY REQUIREMENT OFANY CITY ORDINANC
PLAN CHECK DEPOSIT
DEE OMODIFY, WAIVE OR REDUCE
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ABILITY TO ENFORCE ANYORDINANCE PROVISION,
0 NORLIMITTINAN Y WAYTHE CITY'S
TOTAL AMOUNT DUE
I HERESY ACKNOWLEDGE THAT I HAITE READ THIS APPLICATION; THAT THE INFORM TION
APPLICATION APPROVAL
GIVEN ANOTHAT'A. HE OWNER, OR THE DULY AUTHORIZED AGENT OF -
S COFFC�E.
This IPPlicallOn Is -t p.,j h,lii,,gbld by the
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IMPLOYED
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DOF CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION receipt is a.knowledg d I. sec. p,.v,d.d.
ON THE LA80FI
IN VIOLAWN
WORKMENS COMPENSATION INSURANCE AND RCW 18,27.
OFFICIALS SIGNATURE
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IT IS
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
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0. IVATC PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
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SEPARATE PERWISSION.
STATE SURCHARGE
P EMIT APPLICAD 18� DAYS
PERM
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P. PERMIT LIMIT. I YEAR - PROVIDED ORK IS STA TED WITHIN 180 DAYS
PERMIT U IT ' YEAR -P
-
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
B E BACK FP
'A PLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
-APPLICANT ON BEHALF 0"
DEFEND AND HOLD HARMLESS THE CITY OF
ENG. INSPECTION FEE
INPINTEREST. AGREES TO INDEMNIFY
WASHINGTON. ITS OFFICIALS, EMPLOYEES. AND AG NTS FROM ANY AND
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ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISIN RICTLYORHINCHRECTLY
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0
PLAN CHECK DEPOSIT
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IF EMED To MODIFY. WAIVE R REDUCE ANY REQUIREMENT CT ORDINANCE
, 0 E
0 0 NOR LiMITINANYWAYTHE CIT 'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION
N Y
FIECFJPI
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION
APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
Th� 1pL--I'A- i- I ft
THE OWNER, I AGRE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
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Bull-10111-1-1hi--1 -Pu'y
TION, AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
.pI-.k,,-I.d9.d pl-d.d.
IN VIOLATION OF THE LABOR CODE
WORKMEN S COMPENSATION INSURANCE AND HOW 18,21.
OFFICIALS SIGN TUBE E
T DATE GNED
(4251
LIGNATUREPOWNE" -x -0220 DATE
'L�' 771 !LEASED By
C�i 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- ORIGINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. LED SECTION 109 FAX PINK - OWNER GOLD - ASSESSOR
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