20000890.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
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m SEPARATE PERMISSION.
-=�URCHARGE
PE MIT APPLICATI N; 180 DAYS
PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG REVIEW PEEP
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
F HIS OR HER SPOUSE, HEIRS, A11IGN N S ES RS
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THE o RI D THEREBY, NO PERSON WILL BE
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FOR IN SPECTII
IN VIOLATION 0, THE LABL9 CODE 01 THE STATE OF WASHINGTON
WoRK.EN S CUM�qSA INSURANCE AND RCW 18.21
DATE S GNED
SIGNATURE Q
(425)
771-0220
ATTENTION,"�
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IT
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E E ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE. PUBLIC GRADINGIRLL
'CUR.S. SIDEWALKS, DRIVEWAYS MARQUEES, ETC.) WILL REQUIRE
PERdISSION. J
SEPARATE —5"
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2 ATION: 100 DAYS
PERMIT APPLIC
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EWE 14602 K it RMIT FOR IMS
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ENG. INSPECTION FEE
FO HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
;APPLICANT. ON BEHAL F
NJ :ND FY FEND AND HOLD HARMLESS THE CITY OF LANDSCAPIN
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LS, EMPLOYEES, AND A 'ENTSFROM ANYAND
2 ED..ND..,, A. T..FF INSPECTION FEE
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DAMAGESOFWHATEVER NATURE, A91SINO DIRECTLYOR INDIRECTLY RECEIPT
1 ALL CLAIMS FOR
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT
0 E OR REDUCEANY REQUIREMENTOF ANYCITY ORDINANCE
, DEEMED TO MODIFY. WAIV
CITY'S ABIUTYTO ENFORCE ANY ORDINANCE PROVISION." RECEIPT ul�)
a NOR LIMIT IN ANY WAYTHE
TOTAL AMOUNT DUE - NIZZ) 14
I HEREBY ACKNOWLEDGE THAT I HAVE REA0 THIS APPLICATION: THAT THE INFORM ION APPLICATION APPROVAL
GIVEN IS COR,AECT. AND THAT I AM THE OWNER OTR THE Ogy AUTHDRI.I.ED AGENT .1 T pIim,,,i,,,I,pomj untilsigIldbyth.
THE OWNER, M'Ly"'THC'TYA' 6 AT LAW REGULA CONSTRUC; CALL N'O'plfwi,I , hill— Depull Ad F...
AGREETO 0 Su,ldiq
CORK
TION; AND IN DOING THE W AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYEt
RELATING TO FOR INSPECTION
AlI.CODE 0 THE STATE 01 WASH' NOTCH
IN VIOLATION OFX F
AND ROW 1827. 6 SsiG URE. CAT
A'
DOM URANCE OFFIO
WORKMEN'S I
SIGNATURE (0 NT DATE SIGNED (425) A
1,("31-
'M 771 -N RELEASED By ATE
EXT 333
NTIOW��7
IT IS UNLAWFUL it-LISE OR OCCUPY A 13UILDING 08 STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORtGINAL-FILE YELLOW -INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UlIC SECTION 1119 FAX PINK - OWNER GOLD - ASSESSOR