20000264.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SDEW SEPARATE PERMISSION.
GRADINGIFILL
_E URCHARGS
PERMITAPPLICAT N: 180DAYS
P ER
I PERMIT LIMIT. 1 YEAR. PROVIDED WORK IS STARTED WITHIN IBOOAYS
I I A Y :EA F
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
.F
ENG. REVIEW FEES
A PLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
A PPL
N INTEREST, AGREES TO INDEMNIFY DEFEND AND HOLD HARMLESS THE CITY OF
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EDMONDS. WASHINGTON. ITSOrFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OFWHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
CLA MS F M GEB C
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMITIS. LL NOT BE
0 Y WA'V ANY REQUIREMENT OF ANY C TY ORDINANCE
DEEMEOTO MODIFY. WAIVE OR REDUCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION,
0 Y W Y TH ,
ENO INSPECTION FEE
LANDSCAP NO
INSPECTION FEE
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
RECEIPT
RECEIPT
I HERE Y ACKNOWLEDGE THAT I HAVF READ THIS APPLICATION! THAT THE INr RMATION
GIVEN DIS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO G.Mll WITH CITY AND STATE LAWS REGULATING CONSTRUC
TI.N; AND IN GO' NO THE WORK AUTHORIZED THEREBY NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING To
WORKMEN S COMPENSATION INSURANCE AND RCW 16.27.
OR AGE D2;7E�l
APPLICATION APPROVAL
CALL D I Ad F .1.
1p
FOR INSPECTION
(425)
771-0220
ATTENTION EXT 333
IT IS UNLAWFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE - YELLO - INSPECTOR
A FINAL INSPECTION HAS
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
IINK-OWNER - GOLD -ASSESSOR
�198
TO:
DATE:
MEMOTO: 0 TOR, BUILDING DIVISION
FROM: ---YIRE.DEPARTMENTDAXE
ENGINEERING DIVISION DATE
PLANNING DIVISION DAT
PROJEC
SITE ADDRESS 07141( -7 5
PERMIT 2,6 4 ADBW--------DATE INSPECTED
DESCRIPTION OF WORK,TO BE INSPECTED—
ed ans. Final approval denotes that
Afield inspection was conducted to determine compliance with approv pl
there are no objections from the above signed Department to the granting of:
--,��Final approval ofthe described work
_Performance, Bo nds associated with the project may be released
GRANT FINAL PROJECT APPROVAL
GRANT FINAL PROJECT APPROVAL WITH CONDITIONS NOTED
AILED FINAL INSPECTION - OUTSTANDING ISSUES
2.
3.
-INSPECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
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PER
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PERMIT LIMIT. I YEAR, PROVIDED WORK IS STARTED WITNIN 180 DAYS
Y
P E."'T L' I YEAR
CNG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
C I
ENO. INSPECTION FEE
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'APPLICANT ON BEHALF OF OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
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IN INTEREST. AGREES TO �NDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
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INSPECTION FEE
RECEIPT
A M THE ISSUANCE OF THI ERMIT ISSUANCE OF THIS PERMIT SHALL NOT E
0 ' S P BE
1 0
PLAN CHECK DEPOSIT
DEEMED MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANC
TO
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0 N R T IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROIISION,�
0 LIMIT I N Y W Y T.
ORUMt
TOTAL AMOUNT DUE
RECEIPT
ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
PLICATION APPROVAL
I HEREBY
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT IF
pjj,at,c hot a .-it uhtil �Iglld by the
THE OWNER . I AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
himft, D.'/ end F ... ... I—V
D IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
TION: AN N RELATING TO
WASHINGTO
FOR I ft SP ECTION
I k ... t,dg,
0 OFII�C LABOR CODE OF THE STATE OF
IN ViCLATI N T
NSATION RANCE AND RCW 18,27.
INSU
SI NA RE
WORKMEIVS COM
D:;�
D:;�
(425)
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771 -0220
RELEASE I BY DATE
ATTENTION
EXT 333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
1
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTFI-
.
ORIGINAL FILE - YELLOW. INSPECIOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FA X
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