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PERMIT EXPIRES
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15E PERMIT
CITY OF EDMONDS
ONE
ZONE NUMBER A0072"I
tNAME/SUBDIVISION
CONSTRUCTION PERMIT APPLICATION
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I I I VALUATION I FEE I I
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MECHANICAL
M E C H A N'CA
COVERS WORK TO
THIS PERMIT AUTHO FUZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
OR DING11ILL
2 DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
TT
SEPARATE PERMISSION.
SURCHARGE
PERM TAPPLICATiON: 1110 DAYS
PERMIT LIMIT. I YEAR, PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. REV15W FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENO. INSPECTION FEE
ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIG NS AND SUCCESORS
;APPLICANT,
L, T Y
N INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY Or
ANYAND
LANDSCAPING
E MOND WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM
S.
B TLYO 'NB, ECTL,
EC R
ALLCLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLYOR INDIRECTLY
INSPECTION FEE
TE�CEIPT
x FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
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PLANCHECK DEP051T
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITY�S ABILITY TO ENFORCE ANY ORDINANCE PROVISION�
TOTAL AMOUNT DUE
III EIPT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLJCATION� THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN I CORRECT, AND T AT I AM THE OWNER, OR THE OULY AUTIOR11111 AGENT 01
Th,, ppjj.,P I, P.t , po-1 elil Pghod by the
THE OVIN S REGULATING CONSTRUC
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PERSON WILL BE EMP
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THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
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IN VIOLATION OF THE LABOR CODE OF
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DATE
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RELECSED BY DATE'
ATTENTION
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IT IS UNLAWFUL TO USE OR OCCUPY A BU iLDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL -FILE YELLOW - INSPECTOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
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SETBACKS .....................
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Slab Insulation ..........
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Ceiling Insulation
SHEETROCK NAILING
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SPECIAL INSPECTION
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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THIS.PERMIT AUTHORIZES ONLY THEW RKNOTED THIS PERMIT COVERS WORK TO
GONE N PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CUP.S. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
GQADINGIFILL
SURC ARGE
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT'. I YEAR � PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENG. REVIEW FEES
ENG. INSPECTION FEE
;APpL,.C'AN;�GAN.EE.HALTF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESOFS
� NT 'E R E. 0 INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES. AND AGEMTS FROM ANY AND
NATURE ARISING DIR CTLY OR INDIRECTLY
NDSCAP NO
INSPECTION FEE
A EIPT
FLL- ME FODIMAIISIFW
.C. THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
DEEMED To MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
ANY ORDINANCE PROVISION.'
0 NOR LIMIT IN ANY WAYTHC CITY'S ABILITY TO ENFORCE
1,
H—EiPT
TOTAL AMOUNT DUE
THAT E READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION
APPROVAL
I HERESY ACKNOWLEDGE AAV
:H
GIVEN ISCORRECT.ANDT AT M THE OWNER, OR THE DULY AUTHORIZED AGENT OF
�.,t I ,g.ed by th,
THE OWNER. I AGREE TO COMPLY WITH CITY AND ST E LAWS REGULATING CONSTRUC -
CALL
T .�d F 0.,d, 1
Gui., "ic I,
110"; AMD IN GOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
OF WASHINGTON RELATING TO
FOR INSPECTION
1. I.d,Ld i Sp- p,ov,ded.
IN VI LATION OF THE LABOR CODE OF THE STATE
0
1 B.27.
GAT 5
WORKMEN*S COMPENS��NCE AND RCW
(425)
OFFICIALS NAT
'
DATE
J=R ME
70NED
16 OD
�4 V
771-0220
FELL SEDBY
IATTENTiON
EXT1333
IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
L--
�'T
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTiFl-
YELLOW
ORIGINAL -FILE - -INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK -OWNER - GOLD -ASSESSOR
------------