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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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SEPARATE PERMISSION.
PERMIT APPLICATION; IBODAYS
PERMIT LIMIT I YEAR � PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
F OF 'I'S OR "FIT SP-US E, HEIRS. ASSIGNS AND SUCCESORS
EN. INSPECTION FEE
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APPLICATION APPROVAL
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771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL FILE YELLOW - INSPECTOR
ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
V LKS, DRIVE S, MARQUEES, ETC.) WILL REQUIRE
DOMAIN (CURSS'SIDEWA SEPARATEWEAFIMISSION.
PIS MIT APPLICATION! IBOVAYS
PERMIT LIMIT'. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
HEIRS, ASSIGNS A
;APPLICANT, ON BEHALF OF HIS OR HER SPOUSE.
N INTEREST, AGREES TO :NDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
4
2 EDMONDS. WASHINGTM TS OFFICIALS. EMPLOYEES� AND AGENTS FROM ANY AND
w AS
AULCLAIMSFORDAM E OFWHATEVER NATURE. ARISING DIRECTLYOR INDIRECTLY
x FROM THEISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
9 DEEMED To MODIFY. WAIVE 08 REDUCE ANY RECUtREMENT OFANY CITY ORDINANCE
0 NOR LIMIT IN ANY W—AY THE CITY'S ABILITY TO ENFORCE ANYORDINANCE PA0VIStON,
FLAT NAMEISUBDiVISION NO7__j LOT —NO.—
LID NO,
LID FEE $
OF WA FE OFFICIAL STREET MAP
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REMARKS
OWNERYCONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ENGINEERING REVIEWEDIDATE
FIRE REVIEWED By DATE
VARIANCEOR u
SHORELINE OR AGE.
INSPEO ION
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PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REO'D
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30, Q2�Q C'
VALUATION
FEE
BUILDING
MECHANICAL
GRADINGIFILL
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ENG. INSPECTION FEE
LANDSCAPING
INSPECTION FEE
PLAN CHECK DEPOSIT
RECEIP
TOTALAMOUNTDUE
RECEIPT /S7_ Ll R
14 /_a J� -
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INF RMATION
1. APPLIC ION APPROVAL
GIVEN 15 CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
ThI..p te lid "n"a"."alt ant"itan.d Yin.
THE CYNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
CALL
Ru�ufiag Olit'ittl , nia-, Deputy: and F ... ... paid, and
TION; AND IN OOIN THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
OTHE OF WASHINGTON RELATING TO
FOR INSPECTION
.... ipi is ackamladg,d in pace p,avidoul.
IN VIOLATION OF LABOR CODE OF THE STATE
WORKM COMPENSATION INSURANCE AND RCW 18.27.
0 ,N��UFE DATE
t!j�
RAGENT,
DATE SIGNED
(425)
(425);ZFRE,O
71-0220
7 1 0
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EXT 333
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE - YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX RV—
PINK - OWNER - GOLD - ASSESSO
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