20000713.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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;APPLICANT, ON BEHALF F HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
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STATE SURCHARGE
P' MIT APPLICATION; 180 DAYS
PERMIT LIMIT. 1 YEARNPROVIDED W RK IS STARTED WITHIN IBD DAYS
ENG. REVIEW FEES
SEE BACK O� PINK PERMIToFOR MORE INFORMATION
;APPUE.R�..T�,.Al.- ENI.ILF OF -1 OR HE PI Spo U SE. HEI RS. ASSI GNS AN D SUCC ESO R S
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ENG. INSPECTION FEE
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IN6PfiG=
ALLCLAIMSFORDAMAGESOFWHATEVER
OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
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FROM THE ISSUANCE
REDUCE ANY REQUIREMENTOF ANY CITY ORDINANCE
D EMED TO MODIFY, WAIVE 0 'S TO ENFORCE ANY OR DINANCE PROVISION.
REn
0 HE
08 UNIT IN ANYWAYTHE CITY ABILITY
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS A;PLICATION: THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT I A THE OWNER. OR THE DULY AUTHORIZED AGENT OF
M LATING CONSTRUC-
WITH CITY AND STATE LAW
CALL
T —pplim li ia a-t - P-1-it U-111 11911d by Me
h and Fee, am
THE OWNER. I AGREE TO COMPLY
S=WILL BE EMPLOYED
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FOR INSPECTION
IN VIOLATION OF THE LABOR CODE OF THE STATE OF
DATE
WoRKMEN'S GOMPEN!2Ag =INSURANCE AND ROW 1827.
OFFICIALS SIGNATURE
DATE lIGN10
(425)
11
771-0220
1
DATE
1 SEDBY
—ATTENTION
EXT1333
1"loo
IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
IT
FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CEkTI9.
ORIGINAL: FILE YELLOW - INSPECTDIR
A
HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK -OWNER GOLD -ASSESSOR
CATE OF OCCUPANCY
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