20000860 (2).pdf' DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVER$ WORK To
I: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
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OMAIN (CURSE, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION - -----
STATE SURCHARGE
PERMIT APPLICATION!, 180 DAYS
PERMIT LIMIT., I YEAR - PROVIDED oRK S STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMWIT FOR M086 INFORMATION
ON BEHALF OF His OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
;APPLICAN1
N INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
AULCLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIR501 - — --- , L
ROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
EEMFD To MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
'
DR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDI NANCE PROVISION
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT I AM THE OWNER� OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO C mPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
TION: AND IN DOING THE WoRK AUT"01"'ZTEO ll�IY600 PE SON WILL BE EMPLOYED
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771-0220
ATTENTION 77�
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED, LED SECTION 109
FAX
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DATE RECEIVED
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DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS , MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATIOW 180 DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN ISO DAYS
SEE BACK OF PINK PERMIT ?OR MORE INFORMATION
-APPLICANT ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUC ESOR
IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY 0
EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AN
AULCLAIMSFOR DAMAGES OFWHATEVER NATURE, ARISING D ......
`Hl ISIUA1101 OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT 6
FROM OR NYREQUIREMENTOF ANYCITYOROINANC
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SiGNATU DATE
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DATE SIGN
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JFRCIALS
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771-0220
R EASEDSY
EXT/333
ATTENTION
IS UNLAWFULTO USE OR OCCUPY ASUILDING OR STRUCTURE UNTIL
771-0221
1
IT
I, FINAL INSPECTION HAS BEEN MADE AND APPROVAL 08 A CERTIFI�
ORIGINAL FILE YELLOW - INSPECTOR
GOLO-ASSESS.A
�ATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION �09
FAX
PINK -OWNER