20000480.pdfCD
[PERMIT EXPIRES
1..E
CITY OF EDMONDS
PERMIT
NUMBER 2miao_
JOB
SUITEJAPTN
CONSTRUCTION PERMIT APPLICATION ADDRESSC.�??
OWN R NAMIfNAME 01 BUSINESS
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T.I. P UTHORIZES ONLY THE W.FK NOTE.. THIS PERMIT COVERS WORK TO
ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC GRADING/FILL
BE=A
DOMAIN (CURDS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: ISO DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 1 BO DAYS ENO. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
;APPUCANT. ON BEHAL 0 F HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
IND DEFEND AND HOLD HARMLESS THE Gill C' LANDSCAPING
N NTIREST. AGREES TO EMN"" INSPECTION FEE
EDMONDS. WASHINGTON. IT. 0111.1�!_S. EMPLOYEES. AND AGENTS FROM ANYAND
ALLC�,M�SF�0,UAD�AMAGESolWHATE��n NATURE. �FIEWG DIRECTLYOR INDIRECTLY RECEIPT
THIS PERMIT SH LL NOT BE LAN CHECK DEPOSIT
FROM T. S E 0 LL NOT BE
F ANY CITY ORDINANCE
RDINANCE PROVISION.' R EIPI
TOTAL AMOUNT DUE Ng. C)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION APPLICATION APPROVAL
GIVEN CORRECT, ANDTHAT I A THE OWNER, ORATTEE DUS, AUTHORINZGED AGENT OF Tli. 1�, - . P-1-11 "I" �'I "y "'
THE OWSEk I E TO COMPLY WITH 01 Y AND ST LAW REGULA CONSTRUC- CALL B111-9 Offic� h1d :P.d�F ,, p1ld.
DAGRIT EREDY NO PERSON WILL BE !IPLOYED g.d'iyl
TION: AND IN 01 NO HE WORK AUTHORIZED TH RE ATING TO FOR INSPECTION
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON
WORKMEN'S COMPENSATION INSURANCE AND ROW 18.27. MCI LS SIGNATU DATE
SIGNATURE&Wiq�%OFI AGENT) �GNE. (425)
J-,te- 771-0220 ABED By DATE
ATTENTION EXT 333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221 IECTORI
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE - YELLOW - INSP
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK - OWNER - GOLD - ASSESSOR
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THIS PERMIT AUTHORIZES ONLY THE WoRK NOTED, THIS PERMIT COVERS WORK TO
BE DONE . PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
DOMAIN (..R.., SIDEWALKS, DRIVEWAYS , MARQUEES, ETC.) WILL REQUIRE
SEPVU�ATE PER�ISSION.
STATE SURCHARGE
PERMIT APPLICATI N;, 180 DAYS
o
PERMIT LIMIT I YEAR ' PROVIDED WORK S STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE13ACKO PINKPERMIT IT M INFORMATION
ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCCSORS
ENE. INSPECTION FEE
;APPLICANT.
N INTEREST, AGREES TO :NDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
ANY AND
LANDSCAPING
2 EDMONDS WASHINGTON TS OFFICIALS. EMPLOYEES, AND AGENTS FROM
ALLCLAIMSFOR DAMAGE �OFWHATEVER NATURE.ARISING DIRECTLY OR INDIRECTLY
INSPECTION FEE
RECEIPT
I FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
DEEMEDT MODIFYWAIVEO REDUCE ANY REQUIREMENT OF ANYCITY ORDINANCE
olN
ANY WAY THE CITY EN FORCE ANY ORDINANCE PROVISI ON
0 NOR LIMIT 'S ABILITY TO
TOTAL AMOUNT DUE
P
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPRFJVAL
GIVEN I CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
S
Tj, pp, cal,o, i� . pj, o,,fiI,IX,ed by th,
THEINER. I AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING C ONSTPUC-
CALL
F ,d,,p id. ..d
B'ildift hi,Ml, D.Pdty: :pd
TION; ANDI IND ING THE WORK AUTHORIZEDTH BY. NO PERSON WILL BE EMPLOYED
or Or WASHINGTON RELATING TO
F 0' R INSPECTION oIpI I k,.wlodg ne pro , d
IN VIDLAT ON THE LABOR CODE OF THE SETRATE
RCW 18.21.
DATE
WORKMENS COMPENSATION INSURANCE AND
OFFICIALS SIGNATURE
I SIGNATUREC�WN5 R AGENT) �§IGNED
(425)
JAI
171-0290
LEAS ED BY
ATTENTION
EX-r333
4 ) X,
17 IS UNLAWFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND AP PROVAL OR A CERTiFl-
ORIGINAL - PILE - YELLOW INSPECTOR
ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. LED SECTION 109
FAX
PINK -OWNER - GOLD
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