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VESTED DATE
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS VJOAK TO
BE DDNE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
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DOMAIN (CURES. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
STATE SURCHARGE
I SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
I WITHIN i BQ DAYS
PERMIT LIMIT. I YEAR . PROVIDED WORK IS STARTED
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FDR MORE INFO MATIoN
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'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SU ESORS
NIFY, DEFEND AND HOLD HARMLESS TH ITY P
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DEEMED fO MODIFY. WAIVECOR REDUCE ANY REQUIREMENT OF ANY CITY CADMAN 2
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TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THEOWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
CALL
TION, AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
OF WASHING[ON RELATING TO
FOR INSPECTI,
IN VIOLAT ION OF THE LABOR CODE OF THE STATE
WORKMEN'S COMPEN22��SUAANCE AND RCW 18.21.
_�-IG-M—ATORE 10117" DATE SIGNED
(425)
771-0220
EXT1333
ATTENTION
IT IS UNLAWFUL 70 USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
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DESCRIBE WORK TO BE DONE
REMARKS
_ SPECTIONS PER UBC 1081FINAL INSPECTION REQ
GLAZING I
LOT SLOPE I
PLAN CHECK NO: IVESTEO
DATE
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. SIDEWALKS. DRIVEWAYS ETC.) WILL A .UI.E
SEPARATE PEF�IMAROUEES.
SEIM
2 PERMIT APPLICAR ON: looDAYS
PERMIT LIMIT-, 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
da P LICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
d, �AP ITY OF
N INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
ANY AND
,
2 EDMONDS, WASHINGTON. ITS OFFICIAL$, EMPLOYEES, AND AGENTS FROM
LL CLAIMS FOR DAMAGE S OF WHATEVER NATU RE, ARISING DIRECTLY OR INDI RECTLI
ROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMICTIT"H=CBE
ANY E
EEM ED TO MODIFY, WAIVE OR REDUCE ANY AEOUIREMENT OF
ROVISION.
ANY oRD INANCEPRI
NOR LIMIT IN ANY WAY THE CITY'S ABI TY TO ENFORCE
I HEREBY ACKNOWLEDG E THAT I HAVE READ THI S APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZE. AGENT OF
THEOWNER. I AGREE TO CoMPLYWITH CITY AND STATE LAWS REGULATING CONSTRUC-
EMPLOYED
ION: AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE,
I
I I N VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RE ATING
WORKMEN S COMPENSATION INSURANCE AND RCW 18,27.
SIGNATURE (OWNER
DATE S7D
M/
7-
VALUATION I FEE
3LAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
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ENG. REVIEW FEES
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APPLICATION APPROVAL
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(425)
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771-0220
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R�IEASED By 'AA
ATTENTION r-A 1 1300
ITIS UNLAWFUL TO USE 08 OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR,A CERTIFI- ORIGINAL -FILE YELLOW -INSPECTOR
PINK OW ER GOLD -ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 09 FAX
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