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CITY OF EDMONDS Z.40i NUMBER 7--,60
CONSTRUCTION PERMIT APPLICATION JOB I$: I T PT.
ADDRESS
OWNER NAMEXAME OF BUSINESS LID NE
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PER
LI BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRAOINGIFILL
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
I PERMITAPPLICATI N: ISDDAYS
PERMIT UMITI An, ROVIOED WORK IS STARTED WITHIN 100 DAYS
YE P
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENG. REVIEW FEES
111' OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
;,A,,pLEOAMT,,oANGE,,,ALTF.OF
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S IT' ISSUANCE OF THIS PERMIT SHALL NOT BE
X FROM THE ISSUANCE OF THI PERM
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DEEMED TO MODIFY, WAIVE OR REDUCE ANY EOUIREMENTOF ANY CITY ORDINANCE
-
NOR LIMIT IN ANY WAY THE CITY'$ ABILITY TO ENFORCE ANY ORDINANCE PROVISION.
TOTAL AMOUNT DUE
HAVE READ THIS APPLICATION: THAT THE INFORMATION
E THAT � A. THE OWNER. .1 THE DULY AUTHORIZED AGENT OF
G,,EN S=TEAN`GTNAT
WITH CITY AN. STATE LAWS PE.L'T'N- -ONSTRUC.
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T,ON, AND, ON. ORK AUTHORIZED THEREBY, NO PERSON WILL BE EM LOY D
STATE OF WASHINGTON RELATING TO
FOR INSPECTI,
IN VIOLATION OF THE LABOR CODE OF THE
COMPINIATI INSURANCE AND ICW 11.11.
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FROM: DEPARTMENT DATE —
ENGINEERING DIVISION DATE-
6A"--0—C.A'----PLANNING DIVISION DATE 11-91
PRO T
SITE ADDRESS
PERMIT it E INSPECTED—,
DESCRIPTION OF WORK TO BE INSPECTE
A field inspection was conducted to determine Compliance with approved plans. Final approval denotes that
there are no objections from the above signed Department to the granting Of -
--K--3inal approval of the described work
--D��Perfonnance Bonds associated with the project may be released
GRANT FINAL PROJECT APPROVAL
_GRANT FINAL PROJECT APPROVAL wITH CONDITIONS NOTED
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_FAILED FINAL INSPECTION - OUTSTANDING ISSUES
2.
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_____RF,-INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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RECORD OF INSPECTIONS
PERMIT
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB EPT.
ADDRESS 117��
OWNER NAMEMAME OF BUSINESS
1�4 � 1 0
a / k1 A., k �D N
MAILINOAODRES� ' ' I - G FEE $
.A 57j, roLi T D. P BLIC FIGHT OF WAY PER OFFICIAL STREET MAP TES PA—d 0
0
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
2
BE DONE ON PRIVATE PROPERTY ONLY� AN CONSTRUCTION ON THE PUBL IC
OMAIN (CURBS, SIDEWALKS, DRIVEWAYS , MARQUEES, ETC�) WILL REQUIRE
GRADINGIFILL
1:
SePA RATE PERMISSION.
5 00
PEBMITAPPLICATI. ! 180DAYS
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PERMIT LIMIT. 1 YEAR � PROVIDED WORK IS STARTED WITHIN ISODAYS
ENG. REVIEV� FEES
SEE SACK OF PINK PERMIT FOR MORE INFORMATION
;c)
'A PLICANT. ON BEHAL OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTE EST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
MONDS, WA HINGTON. ITS OFFICIALS, EMPLOY558, AND AGENTS ROM ANY AND
ED F
4W`
ALLCILMMS FOR DAMAGSSOF WHATEVER NATURE� ARISING DIFECTLY.F INDIRECTLY
OF THIS PERMIT., ISSUANCE OF THIS PERMIT SHALL NOT BE
F ROM THE ISSUANCE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINAN E
PLAN CHECK DEPOSIT'
B
01
NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANYORDINANCE PROVISIOCN,�
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT: HAVE READ THIS APPLICATION: THAT THE INFORMATION
'APPLICATION
APPROVAL
GIVEN I CORRECT, AND THAT AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
Th,� ppl-l- pe-I Ultil 519- byth,
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTBUC-
THEREBY. NO PERSON WILL 65 EMPLOY D
CALL
8,,Jd,,g 011i-I 11 h�,, D,puty; a,d F .1. 1
TION; AND IN DOING THE WORK AUTHORIZED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
I COMPENSATi IN URANCE AND RCW IS 27
FOR INSPECTION
�p
WORKMEN S -2 1 o DATE
lIGNATU;:: 11 ENTJ DATE37
'194 Ir '425'
771-02�20
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ATTE(bMOK EXT 333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE U NT11- 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPICIAIL OR A CEFIT�� - Y
SECTION 1"" ORIGINAL 'ILE
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC FAX PINK -OWNER - GOLD -ASSESSOR