20000821.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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REMARKS
PROGRESS INSPECTIONS PER UBC 11081FINAL I
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
ON THE PUBLIC
BE DONE ON PB'WATE PROPERTY ONLY. AN CONSTRUCTION
L .. A. (CUR.S. YMA QUEES, ETC.) WILL REQUIRE
SIDEWALKS, DRIVEWAYS
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=RCIIARGE
AMITAPPLICATI N: 10DAYS
a <2�
PE PROVIDED ORK IS STA TED WITHIN 150 DAYS
PERMIT LIMIT. I YEAR, W R
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENG. INSPECTION FEE
F HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCFSORS
�NAP,'�LTEC�AE'ST�.oA".'�EE"EA.LT"' INDEMNI IY, DEFEND AID HOLD HAR.LE �S THE CITY OF
LANDSCAPING
EDMONDS, WASHINGTON. ITSGFFICIALS. EMPLOYEES. AND AGENTSFROM ANY AND
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ALL CLAIMS F.oR D.AMAGESOF WHATEVER NATUR�.AF0NG.IFECIl.R INDIRECTLY
E OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL N07 BE
PLAN CHECK DEPOSIT
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FROM T.E, UA
cl DEEMED TO MODIFY. WAIVE OR REDUCE ANY FIEQUIRE.ENT OF ANY CITY ORDINANCE
ORDINANCE PROVISION.'
RECEIPT Lb
5 NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANY
TOTAL AMOUNT CUE
III ,
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THAT I HAVT READ THIS APPLICATION; THAT THE INFO MAT-
APPLICATION APPROVAL
I HEREBY ACKNOWLEDGE
GIVEN 11 CORRECT, AND "",I, AM HE OWNER OR THE DULY ALTH.FllED AGENT OF
REGULATING CONSTRUC
CALL
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and F .111,- and
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NE.IA REETO VLY WITH ,TAN6 STATE LAWS
AUTHORIZED THEREBY. No PERSON WILL BE EMPLOYED
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TON AWIND IN D ING THE WG K
I N, CODE OF THE STATE OF WASHINGTON RELATING TO
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FOR INSPECTION
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VIOLATION OF THE LABO
WORKMEN S COMPENSATION INSURANCE AND RCW 1B.27.
L S E, G DATE
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(425)
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771-0220
RE EASED BY
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ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INS CTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
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ORIGINAL-FILE YELLOW - NSP9CTOA
CATE OF OCCU PAN HAS BEEN GRANTED. UBC SECTION 109
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CONSTRUCTION PERMIT APPLICATION ADDREjq.--2,j
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SEPARATE PERMISSION
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E�MIT A0P ATION: Il=S
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ERM JA PROVIDED WORK ED
EE B 0 PINK PERMIT FOR MORE INFORMATION
�APPUCANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, A SSIGNS AND SUCCESDIS ENG, INSPECTION FEE
INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF LANDSCAP NO
N NTEREST, AGREES TO ANYAND
EDIMONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM INSPECTION FEE
A CLAIMS FOR DAMAGESOFWHATEVER NATURE. ARISING DIRECTLYOR INDIRECTLY R PTC.,�� C>4 c
FLFOM THE ISSUA CE OF THIS PERM it SSUANCE OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT TV,
DEEMEDTO MODIFY, WAIVE OR REDUCE ANY A QUIREMENT OF ANY CITY ORDIWANC to
NOR LIMIT IN ANY WAYTHE CITY'S ABILITY TO NFORCE ANY ORDINANCE PROVISION. RECEIPT
TOTAL AMOUNT DUE _/ 3
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLIC ATION; THAT THE INFORMATION -APPLICATION AP-PROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZE. AGENT OF
CALL hil-I p�,,: F p,.d. ..d
THE OWNER. I AGREE TO CO.P WITH CITY AND STATE LAWS REGULATING CONST.UG-
TION: AND IN DOING THE WORKLAYUTH RIZED THEREBY, NO PERSON WILL BE EMPLOYED INSPECTION Plaim .1k,mlodgld 1. spa.0 pro,dod.
M VIOLATION OF THE LABOR CODEOOP THE STATE OF WASHINGTON RELATING TO FOR
WORKMEN'S COMPENSATION INSURANCE AND RCW 10 27. OF I IALS SIG DATE
(425)DATE SIGNED
NATU (OWL'OR A -0220 P
j 771
ATTENTION EXT1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INS ECTION AS BEEN MADE AND APPROVAL OR A CERTIFl- ORIGINAL FILE YELL'
P PINK - OWNER GOLD - ASSE11—
CATE OF OCCUPANCYHHAS BEEN GRANTEE). UBC SECTION 109 FAX
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