20000830.pdfDATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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t: BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC
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2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS , MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT APPUCATION: ISO DAYS
PERMIT LIMIT. I YEAR - PROVIDED W FIX IS STARTED WITHIN ISO DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-APPLICANE ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
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A L LCLAIMS FOR DAMAGES OFWHATEVEA NATURE. ARISING
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DEEMED TO MODIFY, WAIVE OR REDUCE ANY REOUIREMENTOF ANY CITY ORDINANCE
N ANY WAYTHE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
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IRECEIPT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INPORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
TO COMPLY WITH CITY AND STATE LAWS IIE.GNLA�TING CONSTE.C-
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WORKMEN'S COMPENSATION INSURANCE AND RCW 1827.
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
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BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC GRADING/FtLL
2 DOMAIN (CURB% SIDEWALKS RIVEWAYS, MAROUEES. ETC.) WILL REQUIRE
RATE PERMISSION.
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STATE SURCHARGE
PE RMIT APPUCATION: 100,DAYS
WORK JMISRTARTEO WITHIN 180 DAYS
PERMIT LIMIM I YEAR - PROVIDED
SEE BACK OF PINK PERMITFOR INFORMATION
-A PLICANTONBEHAL OF, O,,ER5.,oU S I'S
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AGREES TO INDE , XN HARMLESS THE CITY OF
IN INTEREST. BE A
I EDMONDS. WASHINGTON, ITS OFFICI�LS, EMPLOYEES. AND AGENTS FROM ANY AND
NATURE. ARISING DIRECTLY OR INDIRECTLY HECEIPT
ALLCIAIMS FORDAMAGESOF H VIER
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FROM THE ISSUANCE OF THINATEMIT ISSUANCE OF THIS PERMICTITSYHALL NOT HE PLAN CHECK OEPO IT
DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF AN' ORDINANCE -F-1-5--7 "0
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. RED
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE HEAD THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
OF
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT The pplictu,on te - a Peubut uutil ligIld by IPO
THE OWNER, I AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL B.,Idi,g hillher Deputy: ud F..e .. p.d. nAI
TION: AND IN DOING THE ING THEREBY. NO PERSON WILL BE EMPLOYED d
RK AUTHORIZED T bF.,P I,t,bl.dg.d ut.P.. b
0 THE STATE OF WASHINGTON RELATING
OF THE LAB 0 GO 0 FOR INSPECTION
IN VIOLATION TI
INSUDE
WORKMEN'S COMPENSATIONR PANCFE AND RCeN 18.27.
DATE 11 (426)
SIG WNER Oflf
7 71-0220 RELEASED By
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FULTO USE OR OCCUPY ABUILDING OR STRUCTURE UNTIL
771-0221 /GINAL-FILE
ITISUNL AWP - YELL - INSPECT R
I NS ECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
A FINAL -�'ORFINK - OWNER - GOLD - ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX