20000239.pdfDATE - EIVED
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ERMIT EXPIRES
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PERMIT 2
CITY OF EDMONDS
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NUMBER
JOB
SUITEIAPTN
CONSTRUCTION PERMIT APPLICATION
ADDRESS
OWNER NAMEINAME OF BUSINESS
NO.
MAILING APORESS
FEE $
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ROGRESS INSPECTIONS PER USC 1081FINAL INSPECTION REO'
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VALUATION I FEE
PLAN CHECK FEE
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BUILDING
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,
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
L BE GONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
a DOMAIN (CUnDS, SIDEWALKS, DRIVEWAYS AROUSES, ETC.) WILL REQUIRE
:I SEPARATE PERWISSION.
RC.AF.0
PE RMITAPPLICATI N: 100 DAYS
PERMIT LIMIt I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
ENO. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-A PLICANT. ON BEHAL A ELI ES RS
P FOFHIS ORHER SPOUSE. HEIRS� SSIGNS
ENG. INSPECTION FEE
IN INTEREST, AGRE TOINOEMNI DEFEND AND HOLD HARMILES E ITY F
LANDSCAPING
A'
2 2 EDMONOS� WASHINGTON, ITS OFFI I.S. EMPLOYEES, AND A,ENT F I ANYAN
. A CLAIMS FOR DAMAGES OF WH EVER NATURE.AFttSlNGDI ECTLY NDIRECTLY
7'1 LL AT
INSPECTION FEE
RE SIFT
F 0 SHALL NOT E
R M THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT
PLAN CHECK DEPOSIT
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REOUIREMENTOF ANYC TYORDINANCE
'75
N OR LIMIT WANYWAYTHE CITY'SABILITY TO ENFORCE ANY ORDINANCE PROVISION.�
TOTAL AMOUNT DUE
R EIPT/S/3 P,
I HEREBY ACKNOWLEDGE THAT: HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
Thia te a., . aabat ubtil .11,,.d by er,a
THE OWNER, I AGREE TO COMPLY WITH CITYAND STATE LAWS REGULATING CONSTRUC-
CALL
U, aq OIfa,i I ., himlaar, Cape, 11 eas are Pard,
TION AND IN DOING THE W08K AUTHORIZED THEREBY. NO PEAS N WILL BE EMPLOYED
IN VIOLATION THE STATE OF WASHIONGTON RELATING TO
FOR INSPECTION
rp i-k-1. r. -ded.
OF THE LABOR CODE OF
WORKMENS COMPENSATION INSURANCE AND RCW 18,27�
0 FI LS A DATE
SIGNATURE (OWNERr AGEITI
DATE SIONED 1 1
(425)
I LI) �c
771 -0220
RE EASED BY E
ATTENTION
EXT 333
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. UBC SECTION 109
FAX
PINK - OWNER - GOLD - ASSESSOR
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