20000238.pdfDATE RECEIVED -7
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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CITY 6_]EL
NAME
ADDRESS
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CITY ZIP
NAME
PERMIT EXPIRES —
USE
PERMIT 200238
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NUMBER
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PLAT NAMEISUBDiVISION NO.
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
8 E DONE ON PRIVATE PROPERTY ONLY' Al.ly CONSTRUCTION ON THE PUBLIC
GRADINGIRLI
DOMAIN (CURBS, BI DEWALK ".2-A, ... LESS, ETC.) WILL REQUIRE
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BE APATE PE.M ......
URCHARGE
PERMIT APPLICATION: 100 DAYS
PERMIT LIMIT. I YEAR -PROVIDED WORK IS STARTED WITHIN 180DAYS
ENG. REVIEW FE S
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ON Fill H A ES S
a s OR "ERsPOUSEXNG".R.sL AS� F
ENG. INSPECTION FEE
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LESS T E IT
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AND
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ED VA E TLY RE TLY
CLAIMS FOR DAMAGESOF WHATEVER NATURE,ARISINGD I
INSPE
RECEIPT
ALL
T 15 ISSUANCE OF THIS E IT S LLN TBE
FROM THE ISSUANCE OF PERMIT.
CE
PLANCHEC D POSIT
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT Y ITY R IN
ANY ORDINAN '
RECE
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NOR LIMIT IN ANY WAY THE CITY'S AeIUTY TO ENFORCE
TOTALAMOUNT DUE
7
1 HEREBY ACKNOWLEDGE THAT I HAVE REA. THIS APPLICATI.Ny. 'HAT THEZ I EDFORMA'�'N
APPLICATION APPROVAL
GIVEN 15 CORRECT, AND THAT I AM THE OWNER. C R THE GUL AUH.RI AGENT OF
Th" IPP1110- I' "I I P"", 0 11gled by thO
THEOWNER I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
CALL
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TION. AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
RELA71NG TO
FOR INSPECTION
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IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON
WORKMEN'S COMPENSATION INSURANCE AND RCW 10.21�
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DAT� SIG[,'
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771-0220
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ATTENTION
EXT 333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL NSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE - YELLOW - INSPECTOR
CATE OFIOCCURANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK -OWNER - GOLD ASSESSOR
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OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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CITY
ELEPHOOE
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REQUIRED M YES
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PLAN CHECK NO: rESTID DATE
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t:l BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRU -10 N...,T.. P B -L�l -
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC. LLRE.U, E
SEPARATE PERMISSION.
L
GRADINGIFILL
��S RCHARGE
PERMIT APPLICATION: 180DAYS
PERMIT LIMIT: I YEAR. PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEEBACKOF PINK PERMIT FOR MORE INFORMATION
END. REVIEW FEES
;APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
N INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALLCLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINAN 'E
P
0 NOR LIMIT IN ANY WAYTHE CITY'S ABILITY TO ENFORCE ANY ORDINANCE ROVISION.-
X
ENO. INSPECTION FEE
LANDSCAPING
INSPECTION FEE
RECEIPT
PLAN CHECK DEPOSIT
R OE17 S
TOTAL AMOUNT DUE 55-
t HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFORMATION
GIVEN IS CORRECT AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THEOWNER� I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTAUC
T : AND IN DOING THE WORK AUTHORIZED THEREBY. 10 PIPION WILL BE EMPLOYED
'ION I L ING To
N VIOLAT ON OF THE LABOR CODE OF THE STATE OF WASHINGTON RE AT
WORKMEN.E COMPENSATION INSURANCE AND RCW 18.27,
,C7�RE (OWNER G — OAT
9�
APPLICATioN APPROVAL
CALL Bu�j Thl, 1pptillll.b 1� PO-1 ""IFIlgIld by th,
dj,,gOjr,,j,IhmlbllDlPuIY:ald
FOR INSPECTION ,,M.d9. p—ld.l.
OFFICIALS A BE
(425)
771-0220 ILI IDS
ATTENTION EXT M
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771 -022 1
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL FILE YELLOW - INSPECTOR
PINK -OWNER GOL -ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX