20000414.pdf—I DATE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC GRAOINGIFILL
LKS, DRIVE S, MARQUEES� ETC.) WILL REQUIRE
DOMAIN �CURBS'SIDEWASEPARATEWPEAYRMISSION.
STATE SURCHARGE
PERMIT APPLICATION: "a DAYS
I WITHIN 180 DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK S STA TEO ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMAT ON
ENG. INSPECTION FEE
HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
;APPLICANT, ON BEHALF 0 :lD.EMMICY SPEND AYM�DES HARMLESS THE CITY OF LANDSCAPING
N INTEREST. AGREES To FF �LD A 5NTSFROM ANYAND INSPECTION FEE
2 EDMONDS, WASHINGTON� TS E� E.PL. G
AULCLAIMS FOR DAMAGESOF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY RECEIPT
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT
DEEMED TO MODIPYWAIVE OR REDUtOl ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITY'S AS LITY TO ENFORCE ANY ORDINANCE PROVIStON,� RECEIPT
TOTAL AMOUNT DUE
IHEAE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
By 11 6
, H H, OWNER6 OAT , DDLLY.AUTHOT IGO
GIVEN RE , 1, IN AN ENT OF
'SCOR CTANDT ATAMT C Y AN T TE LAW ED., C STRUC- B"loohn, appli,alion I, ,I , pe,aq notil .,glld by In,
THE WNEF. I A-R E TO -MPLY -IT. 'IT CALL no Offi—I 11 N,— Dopulv� and Fool 11, p,ad, ad
TION; AND IN 00 NO THE WORK AUTHORIZED THEREBY. No PERSON WILL BE EMPLOYED -,,oipl J, —nonalldpon, poll P—old
RELATING TO
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON FOR INSPECTION
WORKMEN'$ COMPENSATION INSURANCE AND ROW 18.27. OFF A S SI NATURE E
E SIGNED (425) 73
. ......... . . 771-0220 RELEASEDty DATE
ATTENTION EXT 333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
ORIGINAL - FILE - YELLOW - INSPECTOR
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- 771-0221
CATE OF OCCUPANCY HAS BEEN GRANTED� UBC SECTION 109 FAX PINK � OWNER - COLD - ASSESSOR
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OWNERNAME.AYME FBUSINESS
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I: BEDONE ROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (ON PRIVATE P ETC.) WILL PEOUIRE
CURBS, SIDEWALKS. DRIVEWAYS, MAROUEES,
SEPARATE PERMISSION.
GRADINGIFILL
STATE SURCHARGE
PE MITOAPPXt -1 Z G. REVIEW FEES
PERMIT LIMIT, I YEAR PA VID IN A ITHiN 180 DAYS N
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
0 -AP LICANT, ON BEHALF OF HIS OR H E SSIGNS AND SUCCESORS
in P 'A SPOUS 'HEI
Y DEFEND RU
!� IN INTEREST AGREES TO INDEMNIF AND HO D HARMLESS THE CITY OF
a EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALLCLAIMS FOR DAMAGESOFWHATEVER NATURE, ARISING DIRECTICE INDIRECTLY
I FR THIS PERMIT. ISSUANCE 0, 'HIS PERMIT SHALL NOT BE
OM.T`T`D'GUAlFY`�' AGE F ANY CITY ORDINANCE
EM M. W IVEOII REDUCE ANY REMIREMENYTOO
ONOR LIMIT IN ANYWAYTHE CITY'S ABILITY TO ENFORCE AN ROINAN111-1.1—
END, INSPECTION FEE
LANDSCAPING
INSPECTION FEE
RECEII T
PI -AN CHECK DEPOSIT
RECEIPT
TOTAL AMOUNT DUE
IHEREB ACKNOWLEDGE THAT I HAVE REA THE INFORMATION
Y 0 THIS A'P"OATK`N� THAT
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE CUL AUTHORIZED AGENT .1
NE . I AGREE To COMPLY WITH CITY ARE A LA N ' CONSTA UC
THE T E BT
OW AN6 ii � WSREGU TI 6 EMPLOYE
TION; AND RIN DOING THE WORK AUTHORIZED E 'i T Re Y. No PERSON WILL BE TI To
IN VIOLATION OF THE LABOR CODE OF TH ATE OF WASHINGTON RELA NO
WORKMENYS COMPENSATION INSURANCE AND IICW 18.27.
ES
S OWNER OR AGI�NT) GAT IGNID
17- p.6
APPLICATION APPROVAL
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CA a Off!"i al 1, lead- Drapery! and Fee, 11 paid. add
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FOR INSPECTION IF i,,,k ... ledger] in ime. P—le.d.
OFF A SI ATURE
(425) 5 /Z -3 /0
j 771-0220 ..RELEASE Y DATE
ATTENTION EXT 333
08 STRUCTURE UNTIL
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING 771-0221 ORIGINAL -FILE YELLOW -INSPECTOR
A FINAL INSP ECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- PINK GOLD-ASEESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX OWNER