20000350.pdfI CONTROUDRAINAGE
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USE
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CITY OF EDMONDS
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NUMBER
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORM TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
REQUIRE
GRADINGIFILL
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL
:I SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT APPUCATIO.� 180 DAYS HIN 180 DAYS
PROVIDED WORK IS STARTED WIT
ENG, REVIEW FEES
PERMIT LIMIT, I YEAR .
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
AGREES T INDEMNIFY, DEFEND AND HOL 0 LESS THE CITY OF
ENG. INSPECTION FEE
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IN INTEREST. =TSFROM ANYAND
ITS OFFICIALS. EMPLOYEES, AND
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ORDINANCE
DUE
THAT I HAVE READ THIS APPLICATION: THAT THE INFO MATION
APPLICATION APPROVAL
I HEREBY ACKNOWLEDGE
-N THE DU'LYAUTH R'ZED AGENT OF
IS CORRECT. AN- THATP' AM THE'0 EFO
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FOR INSPECTION
IN VIOLATION OF THE LABOR CODE OF THE STATE
ANDRCW 18 27�
OFRC L .1 A DtTE
WORKMENS COMPENSATiONiNSURANCE
'71
(425) 111190
SIGNATURE tOWNER DIM
DATE SIGNED,
DATE
7 71
-0220 RE ASE
EXT 333
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------
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221 INSPECTOR
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIF1
ORIGINAL - FILE YELLOW -
GOLD - ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX PINK - OWNER
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