20000362.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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USE PERMIT
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PLAT NAMEISUEGIVISION NO. LOT NO� LID NO,
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REMARKS
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THIS PERMIT AUTHORIZES ONLY THE WORK NOT 0. THIS PERMIT COVERS WORK TO
BE DONE ON pRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS MARQUEES, ETC.) WILL REOUIRE
SEPARATE PER�ISSION.
SURCHARGE
PERMIT APPLICATION: 180 DAYS
R I
PERMIT LIMIT. I YEA � PROVIDED WORK S STARTED WITHIN ISO DAYS
ENS, REVIEW FEES
SEE SACK OF PINK PERMIT FOR MORE INFORMATION
0 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
,W N ITS OFFICIALS, EMPLOYEES� AND AGENTS FROM ANY AND
INSPECTION FEE
OF WHATEVER NATURE, ARISING DIAECTLYOR--
NOT BE
PERMIT SHALL
OF ANY CITY ORDINANCE
PLAN CHECK DEPOSIT
ROMANCE PROVISION.'
ACKNOWLEDGE THATT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
I HEREBY
AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
GIVEN IS COAREC-SEAT00 CONSTHUC�
rTHA'pl
T�E()WNER I ACR �OM Ly WITH CITY AND STATE LAWS REGULATING
WILL BE EMPLOYED
CALL
RON T ORIZED TH ERESY, NO PE RSON
, AND IN DOING THE WORK AU RELATING T
THE STATE OF WASHINGTON
FOR INSPECTION
IN VIOLATION OF THE LABOR CODE OF
WORKMEN S COMPENSATION I NCE AND RCW 18,27
Tj DATE SIGNED
(425)
SIGN (OWN CRAG
91f,
771-0220
EXT 333
ATTENTION
UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
IT IS
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI,
A FINAL
HAS BEEN GRANTED. UBC SECTION 109
FAX
cATE OF OCCUPANCY
E198
VALUATION FEE
4TION APPROVAL
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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' MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
STiM14FSURCHARGE
T APPLIC17
FERMI IN A :FS"q=TyWITHIN 18Q DAYS'
I YEAR � P
EN2fFfk6EW FEES
PERMIT LIMIT.
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT ON BEHALF 0 HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
OF
ENG. INSPECTION FEE
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY
ITSOFFtCIALS. EMPLOYEES. AND AGENTS FROM ANY,AND
LANDSCAPING
INSPECTION FEE
EDMONDS, WASHINGTON.
ALLCLAIMS FOR DAMAGESOF WHATEVER NATURE,ARISING DIRECTLYOR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
pLN CHECK DEPOSIT
DEEMED To MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
PROVISIONW
RECE11'
0 'OR LIMIT IN ANY WAY THE CITY SABILIT TO ENFORCE ANY ORDINANCE
T.TAL..UNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
11.11:11:1 LICATION APPROVAL
GIVEN I FRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
SeCo
pph, 1"' 1, "01 a t Ij,Iill ��g— by 2.
I C ' Re a T
ETo COMPLY WITH CITY TAT A IN NS 2UC
THE OWN AN ' L WS GULAT G C
R EMPLOYED
CALL
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THEREBY No PERSON WILL BE
TION: AND I� DAGINRGETHE WORK AUTHORIZED G Te . W T, To
TA F A IN.T.N FELA No
p.. ;P-d.d.
i Ibnk—W,I0 p,ov,d.d
FOR INSPECTION
IN ,=�N o.�FT.E LTA,...Il CODE 01 THE
ENEA N AND RCW 18.27.
OF, I N TU E
W.g . Co. tSURANCE
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SIGZ(OW,N70R/Aj�,T��V D E SIGN
771-0220�� ELE BED BY DATE
SS
ATTENTION EXT 333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING 0 R STRUCTURE UNTI L 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX