20000537.pdfDATE RECPVED
PERMIT EXPIRES
CITY OF EDMONDS
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THIS PERMIT AUTHORIZES ONLY THE W ORK NOTED. THIS PERMIT COVERS WORK TO
ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
DBEDONE
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SEPARATE PERMISSION-
STATE SURCHARGE
PERMIT APPLICATIO : 180 DAYS
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SEE BACK OF PINK PERMIT FOR MORE INFORMAT ON
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AGREES DEFEND AND HOLD HARMLESS THE CITY OF
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TOTAL AMOUNT DUE
ACKNOWLEDGE THAT I HAVE REA'.T-IRS AppTLIHCEATON,, THAT THE INFORMAI ON
APPLICATION APPROVAL
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GIVEN IS CORRECT. AND THAT I AM THE D NE OR DUL A THOR'ZEDAGENTOF
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TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL LEMPLO TE
WASHINGTON RE ATING 0
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FOR INSPECTION
IN VIOLATION OF THE LABOR CODE OF THE STATE OF
WORKMEN S COMPENSATION INSURANCE AND RCW IB 21.
FICIALS SIGNAT DATE
(425)
11� I
771-0220
REL ASEDS'
EXT033
ATTENTION
IT IS UNLAWFULTO USE OR OCCUPY ABUILDING 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 1 09
FAX
PINK - OWNER GOLD - ASSESSOR
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DATE REC NED
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JOB
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STATE LICENSE NUMBER
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REDO CSTED
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SERA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO.
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSE1
EXP ,
�RSSIDENTIAL
LOT COVERAG REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT)
NEW C] PLUMBING I M CH
ALLOWED PROPOSED FRONT SIDE REAR FRONT UPSIDE REAR
C-] ADDITION COMMERCIAL C MPLIANCE OR
CHANGE OF USE
OT Af DATE
REMODEL APARTMENT C3 SIGN
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REMARKS
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BUILDING Demo
PLA C ECK NO: IVESTID DATE
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS. YS, MARQUEES. ETC.) WILL REQUIRE
SIDEWALKS, DRIVEWA
GRADINGIFILL
SEPARATE PERMISSION
S ATE SURCHARGE
PERMITAPPLICATI N: 180DAYS
V IS
PERMIT L.lMI.r.,lAyEAR -,ROVIDEO WORK IS STARTED WITHIN 180DAY
ENG. REVJEW FEES
Er CK F INK PERMIT FOR MORE INFORMATION
'AFPLIC�AE�,T�CAN.BEHAIF OF H'�l OR HER Sl.USE. ROME, .!5I.N. AN. SUCCESORS
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NTE R ES To NO ARMLESS THE CITY 01
IN MNIFY. DEFEND AND HOLD H
AND AGENTS FROM ANY AND
LANDSC PING
IS EDMOND5jWASHl.l.GTON ITS OFFICIALS, EMPLOYEES
A ATEVER NATURE. ARISING DIRECTLYOR INDIRECTLY
LLCLA. FORD AGE�OFWH
INSPECTION FEE
ECEIPT
FqOM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
0, DEEMED TO MODIFY, WAIVE OR REDUCEANY REOUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAYTHE CITY'SABLITY TOENFORCE ANYORDIMANCE PROVISION.-
RECEIPT
TOTAL AMOUNT DUE
I IHERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
By
APPLICATION APPROVA I I
GIVEN IS CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
ThglO,p'p'Ilc0
THE OWNER, I AGREE TO CO LY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
MP
CALL -I , h,—, Olp`y: Ild F - P.M. .�d
TION: AND IN DOING THE WO AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
ro
INSPECTION ,Pt,k,,wIPdqPdi, p... d.d
IN VIOLATION OF THE LABORRKCODE OF THE STATE OF WASHINGTON RELATING
FOR
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
05FICIALSSI:N:A�E DATE
(425)
S,
!�MNER OR ADEN DATE S
771-0220 REL ABED BY GATE
EXT1333
XTYENTION
ITIS UNLAWFULTO USEOROCCUPY ABUILDINGOR STRUCTURE UNTIL
APPROVAL OR A CERTIFI- 771-0221 ORIGINAL FILE YELLOW INSPECTOR
A FINAL INSPECTION HAS BEEN MADE AND
GRANTED. UBC SECTION 109
FAX PINK - OWNER GOLD - ASSESSOR
CATE OF OCCUPANCY HAS BEEN
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