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u SE CL-52 PERMIT
CITY OF EDMONDS ONE NUMBER 2tW0
CONSTRUCTION PERMIT APPLICATION 3 B SUITE/APTO
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t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
a DOMAIN (CURBS, SIDEWALKS, DRIVE AYS , MAIAOUEES. ETC.1 WILL REQUI RE
:I SEPARATE PERMISSION.
P RMIT APPLICATION: 1BODAYS
6
1 TED WITHIN 180 DAYS
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PERMIT LIMIT.- 1 YE
SEE BACK OF MIT FOR ORE INFORMATION
PINK PEA
ON BEHALF OF HIS OR HER SPOUSE� HEIRS. ASSIGNS AND SUCCESORS
�APPLICANT,
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DEEMEDTO MODIFY, WAIVE 08 PEDUCEANY REQUIREMENT OF ANY CITY
N LITYTO ENFORCE ANYORDINANCE PROVISION.'
OR LIMITIN ANYWAYTHE CITYISABILITY
I HEREBY ACKNOWLEDGE THAT I HAVE READTHIS APPLICATION: THAT THE INFORMATION
C DULY AUTHORIZED AGENT OF
GIVEN IS CORRE T, AND THAT I AM THE OWNER6 OR THE t
CONSTRUC
THE OWNER. I AGREE TO COMPLY WITH CITY AN STAT LAWS REGULATING
THEREBY, NO PERSON WILL BE EMPLOYED
TION; AND IN DOING THE WORK AUTHORIZED
IN VICLATIO OF THE LA R CODE OF THE STATE 0 WASHINGTON RELATING TO
WORKMEN'S COMPENSMARANCE AND RCW 18-27.
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SIGNATURE
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ROGSESS INSPECTIONS PER UBC I08/FINAL INSPECTION RED
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VALUATION FEE
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ENG. REVIEW FEES
ENG. INSPECTION FEE
LANDSCAPING
INSPECTION FEE
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
CALL
FOR INSPECTII
(425)
771-0220
ATTENTION EX 1 .33.1
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-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK T.
BE D NE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUULIC
D 0 S. MARQUEES, ETC.) WILL RED ME
OMAIN (CURBS,SIDE LKS,DRIVE AY
SEPARATE PERMISSION,
GRADINEPFILL
STATE SURCHARGE
PE MITAPPILICATI N: 180DAYS
PERMIT LIMIT'. 1 YEAR � ROVIDED WORK IS STARTED WITHIN ISODAYS
Is
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENG. REVIEW FEES
;A PLICANT. ON BEHALF 0 S1 E"USSIQNSA NO SUCCESORS
F' 'R PER -P=
NPINTEREST. AGREES TO W.E.101. -I-- -4HC-HAFIMLESSTHE.4ITYOF
a EDMONDS. WASHINGTON. ITS OFF ALS. EMPLOYEES. AND AGENTS FROM ANY AND
OF HAgV DIRECTLY
ALL CLAIMS FOR DAMAGES W ER NATURE, ARISING onRECTLYOR IN
x FROM THE ISSUANCE OF THIS PERMIT. SSUANCE OF THIS PERMIT SHALL NOT BE
9 DEEMED TO MODIFY. WAIVE OR REDUCE ANY REOUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY To ENFORCE ANY ORDINANCE PRO"ISION�
ENG. INSPECTION FEE
TANDSCAPING,
INSPECTION FEE
RECEIPT
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, A D THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT 01
THE OWNER. REETOCOMP WITH CITY AND STATE LAWS REGULATING CONSTRUC
JAG N LY
TION: AND IN DOING THE WORK AUTHORIZED THEREBY. N PERSON WILL BE EMPLOYED
IN V! LATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND ROW 18.27.
0
S12URE JOWN:M j DATE SIGNED
anj
APPLICATION APPROVAL
CALL In, applic.liGn is not a penatil until signed by the
di g'ohj,j I IsMen Deputy: Ild Pass am P". and
B'jjTh 'h
FOR INSPECTION ecoipl is ucammuedged In &Ipaw provided. ; L
-01CIALI 1ICNAILRE DATE
oo
(425) DATE
771-0220 REIlEASED BY
ATTENTION EXT 333
IT IS UNLAWFUL TO USE 08 OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI�1- ORIGINAL - FILE YELLOW - INSPECTOR DO
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK - OWNER - GOLD - ASSESSOR - ' 5
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