20000306.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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VESTED DATE
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.IS P AUTHORIZES ONLY THE WORK H.TEG. THIS PERMIT COVERS WORK TO
E 0. PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
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DOMAIN (CURBS,SIDEWALKS, DRIVEWAYS. MAROUEES,ETC.) WILL REQUIRE
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STATE SURCHARGE
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT'. I YEAR � PROVIDED WORK IS STARTED WITHIN DAYS
STORM DRAINAGE FEES
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AN. SUCCESORS
IN.INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY F
E MOND$. WASHINGTON. TS.FlICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
AULCILAIMSFORDA AGESOPWRATEVER NATURE. ARISING DIRECTLY OR NU�PECTLY
M OF THIS PERMIT $HALL NOT BE
FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE
EDTO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT DEAN' CITY ORDINANCE
NOR LIMIT IN ANYWAY THE CITY'S ABIILITYTO ENFORCE ANY ORDINANCE 1H.V I ON
DEEM I I -
ENG. INSPECTION FEE
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. TIHAr INFORMATION
GIVEN ISC.RFIECT.ANO THATI AM THE OWNER. ORTHE DULyAUIH , EDAGENTOF
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS EGULATING CONSTRUC
TICK. AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN S COMPENSArION INSURANCE AND ROW I Ell
IIGNAIIN ATE SIGNED
APPLICATION APPROVAL
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771-0220
LEASED BY
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I r IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL IN S PECTION MADE AND APPROVAL OR A CERTIFI-
ORIGINAL 'ILE YELLO' INSE11,MH
HAS BEEN
CATE OF OCCUPANCY HAS BEEN GRANTED. UGG SECTION 109
PINK OWNER GOLD ASSESIOR
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SETBACKS .....................
FOUNDATION:
Footing ......................
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Slab Insulation ..........
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Ceiling Insulation
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SPECIAL INSPECTION
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FINAL APPROVAL FOR
OCCUPANCY ..................
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PERMIT EXPIRES
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CITY OF EDMONDS
NUMBER
PERMIT APPLICATION
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OWNER NAMEINAME OF BUS NESS
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REMARKS
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
DOMAIN (CURBS.SIDEWALKS. DRIVEWAYS MAlQUEES.ETC.)l_ REQUIRE
L SEPARATE PERWISSION.
STATE SURCHARGE
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHI� 100 DAYS
STORM DRAINAGE FEES
END. INSPECTION FEE
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIBS. ASSIGNS AND SU CCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY Or
EMPLOYEES. AND AGENTS FROM ANY AND
m EDMONDS, WASHINGTONt, ITS OFFICIALS,
FOR DAMAGES 01 WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
ALL CLAIMS
FROM THE ISSUAN OF THIS PERMIT ISSU NCE OF THIS PERMIT SHALL NOT BE
CE
PEA C ECK DEPOSIT
AN ANCE
0 DEEMEDTOMODIF Y HEQUIREmeN r OF ANY CITY ORDII
Y. WAIVE OR REDUCE �
NOR LIMIT IN ANYWAY THE CITY'S ABILIT TO ENFORCE ANY ORDINANCE PROVISION
TOTAL AMOUNT DUE
EDGE I HAT I HAVE READ THIS APPLICATION. THAT 1.1E NF.RNATK)N
APPLICATION
APPROVAL
IHEREBYACKNOW
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
'Ya"T
THE 0 NEB. I AGREE TO COMPLY WITH CITY AND STATE LAWS REG LATING CONSTRUC-
W BE EMPLOY
c ALL d
ffi..19 Off
ION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL
L
WASHINGTON RE ATING TDO
FOR INSPECTION �d rd'. pl-d-
IN VIOLATION OF THE LABOR CODE OF THE STATE OF
WORKMENSCOMPENSATI.NINSURANCE NDRCWIB21.
AIESIGNED
(425) OFF11 ALS IONAT
fTl
SIRNATUR OWNERORAGE
771-0220
DAiE
LEASED BY
ATTENTION
USE OROCCUPY ABUILDING OR STRUCTURE UNTIL
ITIS UNLAWFULTO
S PECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI,
ORIGINAL FILE
YELLOW INSPEG101
ASSES11-
A FINAL IN
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER
GOLD