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CONSTRUCTION PERMIT APPLICATION
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BE DOME ON PRIVATE PROPERTY ONLX AN CONSTRUCTION ON THE PUBLIC
GRADING/FILL
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYSYMARGUEES. ETC.) WILL REQUIRE
SEPARATE PER�ISEION,
STATE SURCHARGE
PERMIT APPLICATION: 10 �AYS
0
PERMIT LIMIT. 1 YEA9R - 91ROVIDED W FIX IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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ALLCLAIMS FOR DAMAGESOF WHATEVER NATURE.ARISING DIRECTLYOR R-T Y
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INSPECTION FEE
RECEIPT
c FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
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I NORLIMITIMAN WAY THE CITY'S ABILITY TO ENFORCE ANY
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TOTALAMOUNTDUE
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER. 08 THE DULY AUTHORI EDAGENTOF
THE OWNER I AGREE TO COMPLY WITH CITY AMD STATE LAWS REGULATING CONSTRUC
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IN VI.AlNA'TlGN`G'lNG-E�.Q` OF THE STATE OF
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WORKMENSCOrEN TIC I SURANCE AND RCW 18.27.
OFF A IONA
ME/
DATES
(425)
771-0220
Y
EXT 333
RELEASED
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL IN PECTION HAS BEEN MADE AND APPROVAL OR A.CERTIFI.
S
RIGINAL FILE - YELLOW INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 10
FAX
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RECEIVED
CITY COPY
APR 2000
DEVELOPMENr SERVICES CTFL
CITY OF EDMONDS
731 ALIER PROPERTY
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PROPERTY OWNED BY RON GORBVE[ & ROCHELLE GOLDBERG
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OWNED BY RON flORnVEC &,ROCHELLE GOLDBERG
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE .. E ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN 'CURES, MARQUEES, ETC.) WILL REQUIRE
SIDEWALKS, DRIVEWAYS.
SEPARATE PERMISSJON�
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a
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
LICANT, ON BEHALF 0 Fill S OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
;AP
N INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
Y AND
2 EDMONDS. WASHINGTON ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM AN
ALLCLAIMS FOR DAMAGEi OF WHATEVER NATURE, ARISING DIRECTLYOR INDIRE-1
�M
m FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
m DEEMEDTO MOOIFY,WAIVEOR REDUCEA`Y REQUIREMENT OF ANY CITY OSDINANC�
PROVISION,
NOR LIMIT IN ANY WAYTHE CITY'S ABILITY TO ENFORCE ANY ORDINANCE
I HEREBY ACKNOWLEDGE THAT: HAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT AM THE OWNER. STRATTEE D.SLYRALTHOTRIINZGED AGENT OF
THE OWNER, I AGREE TO COMPLY WITHCITYANO LAW EGULA CNSTRUC
TION AND N DO NO H RK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
TO
IN VI bl-ATION OF THE a A (;OIJE OF THE STATE OF WASHINGTON RELATING
WORKMEN'S C05PEN TiON INSURANCE AND RC. 18.21.
DATE s7;
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VALUATION FEE
PLAN CHECK FEE
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BUILDING
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ENG. INSPECTION FEE
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INSPECTION FEE
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RECEIP
TOTAL AMOUNT DUE
APPLICATION APPROVAL
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CALL
B,,Id,.g 011,c;al r h."hll Dap,j, and Fada d. ad
FOR INSPECTION
,knowildold In IF— F d.
(425)
OFF CIA ON q
/� ATE
771-0220
RELEASED I Y DATE
—ATTENTION CTURE UNTI r_A 1 1�00 I
771-0221 96GINAL NILE YELLOW- INSPECTOR
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTI
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- PINK - OWNER GOLD - ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109 FAX