20000749.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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E DONE ON PR.A PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS MARQUEES, ETC) WILL REQUIRE
SEPARATE PERWISSION,
RMIT APPLICATION: I8GOAYS
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PERMIT LIMIT'. I YEAPE - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
�APPUCANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCFSORS
IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY 0
2 EDMONDS. WASHINGTON. ITS OFFICVILS� EMPLOYEES, ANf7I AGENTS FRO. ANY AND
1. ALL CLAIMS FOR DAMAGE OFWHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
I FR M UTHE ISSUANCE OF T. S PERMIT. ISSUANCE OF THIS PER.IT,SHALL NOT 6
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USE PERMIT
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I HEREBY ACKNOWLEDGE THATI HAVE READ THIS APPLICATION, THATTHE INFORMATION
APP ICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
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TION� AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
STATE OF WASHINGTON RELATING TO
FOR INSP TION 1110d9ld 1� SpIca prowded
IN VIOLATION OF THE R CODE OF THE
WORKMEN S COMPEN SURANCE AND RCW 18.27�
OFF ALS SIGNATURE DATE
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HAS BEEN MADE AND APPROVAL OR A CERTIFI-
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REMARKS
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ROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REQ'D
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VALUATION
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PLAN CHECK NO: 00 -.347
111STED DATE
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS . MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
STATE SURCHARGE
ITAPPLICATI N: 150DAYS
PERMIT LIMIT. I YEPERM
AR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG, REVIEW FEES
SEE BAC K OF PINK PERMIT FOR MORE INFORMATION
P LICANT, ON BEHALFOFHISOR HER SPOUSE. HEIRS. A$SIGNSAND SUE CESo S
A P C RF
IN NTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS TH CITY
I o
LANDSCAPING
EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANYAN o
A.L CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECT Ly
INSPECTION FEE
00
-7(o
FL MIT, ISSUANCE OF THIS PERMIT SH ILL NOT BE
0 ROM THE ISSUANCE OF THIS PER NYCITYOROINAN E
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENTOF �
PLAN CHECK DEPOSIT
,
0 NOR LIMIT IN ANY WAYTHE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION�'
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
T
APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
T�!PPLII�A�1�14
y
AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONST
THE OWNER. I RUC,
6MPL oYED
.
CALL BIIIIIiii of1_1 h,�,h., D puly: ,d F111 11, p id, -d
TION: AND IN DO NG THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE
I'
THE STATE OF WASHINGTON RELAT114G To
d-p... p-id.P.
FOR INSPECTION
IN VIOLATION OF THE LABOR ODE OF
WORKMEN'S COMPENSATION INCSURANCE AND RCW 18-27.
URE DATE
(425)
I I I-`U44V -AEASEDBY
ATTEM'ft:hq'
EXT 333
IT IS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTIL 771-0221
FINAL INSPECTION HAS BEEN MADE AND APPROVAL 08 A CERTIFI- ORIGIN FILE YELLOV� INSIECT.R
A
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX PINK GOLD AES59SOR