20000681.pdfr-"N DATE: RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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CITY ZIP 9LEPHONE
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NAME
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NUMBER
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REMARKS
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THIS PERMIT AUTHORRES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
ON. o T. AS USE. TO
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PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
BE DONE ON PRIVATE
I "WA TC) WILL REQUIRE
DOMAIN (CURBS, SIDEWALKS, AIVEWMYS, MARQUEES. ETC.) WILL REQUIRE
DOMAIN ICU AGE S
SEPARATE PERMISSION.
STATE SURCHAA.E
PER ITAPPLICATI.N: 111OMS
P E'M
PERMIT LIMIT. I YEAR -PROVIDED W RK IS STARTED WITHIN IBDDAYS
A A
PERMIT L M T I & P
ENG REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
SEE ACK OF P
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-APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESDHS
AEPL'CAK' - BE 'AL F OF E
ENG. INSPECTION FEE
IN NTERSST. AGREES TO INDEMNIFY DEFEND AND HOLD HARMLESS THE CITY OF
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E EDMONDS� WASHINGTON. ITSOFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
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LANDECAP NO
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% ALL CLAIMS FOR DAMAGES 05WHATEVER NATURE. ARISING DIRECTLY 09 INDIRECTLY
ALLEEA`VS FDA D A - AGES OF
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IS
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m FROM THE ISSUANCE OF THIS PERMIT.
FROM THE I UA
0 DEEMEDT MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY OIADINANc
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I HEREBY ACKNOWLEDGE THAT: HAV I HEAD THIS APPLICATION THAT THE INFORMATION
APPLICATION
APPROVAL
GIVEN IS CORRECT AND THAT AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
TRUC
THEOWNER I AGREE TO COMPLY WITH C17Y AND STATE LAWS REGULATING CONSTRuc
EMPLOYED
E E P OYE
CALL
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ION AND IN OING HE WORK AUTHORIZED THEREBY. NO PERSON WILL BE
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THE STATE OF WASHINGTGN RE L T
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FOR INSPECTION
I N V16LATION OF THE LABOR CODE OF AATING
WORKMEN S COMPENSATION INSURANCE AND RCW I B.2T
OFFI ALS SIGN TURE DATE
LWI AG
DATE SIGNED
(425)
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771 -0220
RELEASED BY DATE
ATTENTION
EXT 333,
V121100.
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
—TW
FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGNAL FILE - YELLOW - INSPECTOR
A
CATE OF OCCUPANCY HAS BEEN GRANTED. LIBC SECTION 109
FAX
PINK OWNER - GOLD ASSESSOR
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