20000249.pdfPERMIT EXPIRES
PERMIT 200249
CITY OF EDMONDS Cl
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CONSTRUCTION PERMIT APPLICATION JOB SUITE/Ael 4
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NAME
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PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZ!S ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2 (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
CAADINGII'LL
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STATE SURCHARGE
PERMIT APPLICATION: 1 00 DAYS
PERMITUMIT.1 AR " PROVIDED WORK IS STARTED WITHIN 180 DAYS
YE
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF 0 HIS OR HER SPOUSE, HEIRS, A SI NS D SLI ES S
REES To NDEMNIFY, DEFEND AND HOLD LEI T E ITY F
ANY AN
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PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
F ANYCITY ORDINANCE
PROVISION. -
ROINANCE
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVTE READ THIS APPLICATION; THAT THE INF RMATION
HECOWNER RATES -ULy AUTHORIZED AGENT OF
GIVEN ISCORRECTANDTHATIAM
ITYA 60
ST LAW R'.UWINO CONSTRUG
CALL
THE OWNER
7ION; AND "IeG RX ED THEREBY. NO PERSON WILL BE EMPLOYED
'IV 'lAGPlTEH`60WOMl=IZ
RELATING TO
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FOR INSPECTI,
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON
WORIM111S COMPENSATION INSURANCE AND HOW IS.27�
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(425)
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771-0220
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EXT 333
ATTENTION
ITIS UNLAWFULTO USE OR PYABUILDING 08 STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. USO SECTION 109
FAX
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VALUATION I FEE
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DESCRIBE WORK TO BE DONE
REMARKS
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HEAT SOURCE GLAZING I LOT SLOPE % BUILDING
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MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONS�TRUCTR)N ON THE PUBLIC GRADINGIFIL
DOMAIN (CURBS, SIDEWALKS FBTEWAYS GUESS, ETC.) WILL REQUIRE
PE WIMAR
RA . SSION.
EE�AG
MIT APPLIC
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A. PERMITLIMIT.1 AR -PROVIDED WORK IS STARTED WITHIN 180C
SEE SACK OF PINK PERMIT FOR MORE INFOOMATION
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'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUC ESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF NOSC PING
M
EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANYAND
INSPECTION FEE
RECEIPT
A L LCLMMSFOR DAMAGESOF WHATEVER NATURE. ARISING DIRECTLYOR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
,0
0
DEEMEDTO MODIFY, WAIVE OR REDUCE ANY REQUIREMENTOF ANY CITY ORDINANCE
IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION,'
RECEIPT
NOR LIMIT
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
Thil IpPlicallO� '� - � .11 u,,lil �ig by lb.
Pg'vy:
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC�
CALL
B,Mding O,cj., �, lj, 0 ,d F ,I,d. .�d
TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
OF WASHINGTON RELATING TO
FOR INSPECTION
,,pt m Ilk —lodged m P'd-�
I N VIOLATION OF THE LABOR CODE OF THE STATE
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27�
OFFICI SIGN OATE
.4— DATE SIGNED
(425)
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OWNER OR AGENT) 1-
A - .;5(). o 0
771-0220
18L B
EXT 333
7
ATTENTION
PY A BUILDING OR STRUCTURE UNTIL
771-0221
ITISUNLAWFULTOUSEOROG,r
BEEN MADE.AND APPROVAL OR A CERTIFI-
ORI AL -FILE
A FINAL INSPECTION HAS
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER GOLD - ASSESSOR