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PERMIT EXPIRES
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PERMIT
CITY OF EDMONDS
NUMBER
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ESURCHARGE
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fAIII, INSPECTION FEE
;APPLICANT ON BEHALF OF HIS OR HER SPOUSE, HEIRS� ASSIGNS AND SUCCESIDES
N NTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY
2 EDVONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANYAONE
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TOTALAMOUNTOUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION
APPROVAL
GIVEN IS CORRECT, A 0 THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
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TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
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771-0220 `rL AS9
ATFENTION—
EXT 333
ITISUNLAWFULTOUSEOROCCUP A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL 'ILE Y
CATE OP OCCUPANCY HAS SEEN GRANTED. UBC SECTION 109
FAX PINK - OWNER GOLD ASSESSOR
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ENGINEERING DIVISION DATE—
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DEPARTMENT OF BUILDING
RNE
R UNIFORM BUILDING CODE SECTION
Buildiem'Aritm #2 22
Occupancy established by this c ate: Dwel ling Units: -KVA- N No. Stories: 1
-1fC J, rporistruct.l....".: V-1 Hour
Basement: NIA
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Maximum B.C. 1002)
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Owner of Building:' Dr..Thomas Dea Ac Edmonds. WA 98026
THE ---- Krum Clinic OPLYING'WITH THE REQUIREMENTS OF THE
:L99_7 EDITION OF THE UNIFORM BUILDING FFv NO DIVISION OF OCCUPANCY AND THE USE
FOR WHICH THE PROPOSED OCCUPANCY IS D.
Issued this 2nd 2000
BY.
W- -Mi W-11 tn� P-t-d 1-01.— Pbl. d.lulf not W —..d, MIAVated orob—d and —1 M Tainhilned In WGIN$ —dil.an WI I.-
Ce,ifficate d Ccaqarcy inmued by Me City d Eftonds Building 011INal.
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
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VALUATION
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13 L(.�_
-PLAN CRECK NO:'
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LUMBING
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THIS PERM T AUTHORIZES ONLY THE WORK WTED. THIS PERMIT COVERS WORK TO
BE 004E ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PU' "'
L DOMAIN (CUASS. SID S FE.LBRE
EWALKS, DRIVEWAY � MARQUEES, ETC.) WILL
3 SEPARATE PERMISSION,
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GRADING/FILL
STATE SURCHARGE
RE MIT APPLICATION: i80DAYS
A. PERMIT LIMIT. I YE ARRPROVIDED WORK 19 STARTED WITHIN 180 DAYS
SSE BACK OF PINK PERMIT FOR MORE INFORMATION
S OR HER SPOUSE, HSIRS. ASSIGNS AND SUCCESORS
FY� THE CITY F
N NT R ES . 1. EMN' DEFEND AHO .. . HARMLESS
;AFPLI�l.A�l.TjCAN.lEHALl, "'. L
a EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
IF DIRECTLYORINDIRECTO
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I HEREBY ACKNOWLEDGE THATI HAVE RgADTHIS APPLICATION; THAT THE IN50RMATION APPLICATION APPROVAL
GIVEN IS CORRECt. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT 01 Thppl,,on I, , p,mit u�j I ll,od by thl
.1 0 T ... ... d.
THE OWNER� FEE To COMPLY WITH.CjTy AND STATE LAWS REGULATING CONSTRUC. CALL BWdj�OII,$b,h,llh7 p.ty;�nd
TION; AND IN DOING THE WORK AUTHO ZED THERE Y. N PERSON WILL BE EMPLOYED 11 li wt.dg.din ... t. Pldbd
IN VIOLA N OF F TIE ST T BOF ASHINGTON RELATING TO FOR INSPECTION
E COMPENS CE RC .27. DATE S (425) OF ICI �AT E
WORK S�p A
SIGIA OW I ED
/00 ATE
771-0220 RELEASE� BY-,
�ENTm EXT 333
'AABUILDING OR STRUCTURE UNTIL 10.1,2 do
IT IS UNLAWFUL TO USE OR OCCUR 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE - YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS SEEN GRANTEO. UBC SECTION 109 FAX PINK -OWNER - GOLD - ASSESSOR
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