20000469.pdfiI DATE RECEIVED
CITY OF EDMONDS �
CONSTRUCTION PERMIT APPLICATION
OWNERNAMEINAMEO BUSINESS
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PLAT NAMEISUBDIVISION NO.
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTEM THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGiFiLL
WAY
DOMAIN (CURBS, SIDEWALKS, DRIVE S. MAROUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION,
SURCHARGE
PERMIT APPLICATION! 180 DAYS
PERMIT LIMIT. I YEAR - ROVIDED K S STARTED WITHIN ISO DAYS
P WOR I
ENG, REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
�A PLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
INPINTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAP NG
EDMONDS, WA HINGTON. ITS OFFICIALS� EMPLOYEES. AND AGENTS F ROM ANY AND
S
INSPECTION FEE
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE' ARISING D IITECTLY OR INDIRECTLY
NOT BE
FROM THE ISSUANCE OF THIS PERMIT. ISSUA NC, OF THIS PERMIT SHALL
DEEMED TO MODIFY. WAIVE 08 REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
PLAN CHECK DEPOSIT
0.
NOR LIMIT IN ANY WAYTHE CITY'S ABILITY TO ENFORCE ANYORDINANCE PROVISION.
TOTAL AMOUNT DUE
'S -0
I H�: �FSY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIV �T IS CORRECT. A 0 THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
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WASHINGTON RELATING TO
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IN Vk)LATION OF THE LABOR CODE OF THE STATE OF
WORK'AEN S COMPENSATION INSURANCE AND RCW 1827�
OIFOIAIJ!La� DATE
SIGNAIIIREIOWNER�
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771-0220
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A FINAL IN PECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE - YELLOW
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK - OWNER - GOLD - ASSESSOR
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CONSTRUCTION PERMIT APPLICATION
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ROVIDED ORK IS STARTED WITHIN 180 DAYS ENG. REVIEW FEES
PERMIT LIMIT. I YEAR - P w
SEE BACK OF PINK PERMIT FPR MORE INFORMATION CESORS S
ENG, IN �l
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGH5 AND SUCC11ORS
I I AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THh QIIYN�o L[AN.SCAPING
N FITEREST,
E MONDE. WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENT' FROM ANY INSPECTION FEE
ALDLCLAIMSFOR MAGESOFWHATEVER NATURE. ARISING OIRE.TLYORINDIRECTLY RECEIPT
i FROM THE ISSUADANO' OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT
DEEMED To MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OFANY CITY ORDINANCE
NORUMIT INANYWAYTHE CITYBASILITYTO ENFORCE ANYORDINANCE PROVISION.-
T TAL AMOUNT DUE 1 5,S, I;D
I HERE Y ACKNOWLEDGE THAT: HAVE READ THIS APPUCATION� THAT THE INFORMATION APPLICATION APPROVAL
GIVENIIS CORRECT� AND THAT AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF T a, is he, , p"mil ,III bqPPel by 11.
I CIULATILN�G CISTRIG I aall
THEOWNER. IAGRE TOCOMPLY WITH CITY AND STATE LAWS RE WL EcE.P.N. CALL lhil.lgilollhl�lll , "S/lba, Nputy::,d Fees am p,,d.
TION, AND IN DOING THE WORK AUTHORIZED THEIIEBY, NO FERSO , ... pt,—knowtoagodi, p,mp,,Y,dld.
IN VIOLATION OF THE LABOR CODE .5 THE STATE OF WASHINGTON RELATIqb TO FOR INSPECTION
WORKMEN'S COMPENSATION IN SURANCE AND FtCW 18.27. OF
ISIGNATURE 4OWNER FIArENT) —1 SIGNED �(425)
2-L-i 771 .RlrlEA§ED.Y F OWE
i�-opl -0220
ATTENTION EXT 333
IT IS UNLAWFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL FILE YELLOW - INSPECT 11
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109 FAX PINK OWNER GOLD - ASSESSOR