20000903 (2).pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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REMARKS
OWNERCONTIRACTOR RESPONSIBLE FOR EROSION CONTADUDRAINAGE
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OYES ONO
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COMPLETE I EXEMPT ALLOWED I PROPOSED ALLOWED , PROPOSED
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PLUMBING
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MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
LKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
OMAIN (CURDS'SIDEWA SEPARATE PERMISSION.
GRADINWFIt.L
STATE SURCHARGE
PE MIT APPLICATION: 180 DAYS
PERMIT LIMIT. I YE ' PROVIDED WORK IS STARTED WITHIN ISODAYS
ARR
SEE BACK OF PINK PERMIT FOR MDRE INFORMATION
ENG. REVIEW FEES
;APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY DEFEND AND HOLD HARMLESS THE CITY It
2 EDMOND% WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
5 ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING 0 111. - — 1111-1 1
at FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
I DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDI HANCE
5 ROVISION.'
NOR LIMIT IN ANY WAY THE CITY'S AS LITY TO ENFORCE ANY ORDINANCE P
S G, INSPECTION FEE
PLAN CHECK DEPOSIT
TOTAL AMOUNT
"'LL't
E ' In
AT ON THAT THE INFORMATION
I HEREBY ACKNOWLEDGE THAT I AVE NSA() THIS APPTLI�Cl G.LY' AUTHORIZED AGENT OF
GIVEN I CO RECT, AND THAT I AM TH OWNER
S "AGR E To .PLY WIT IS Ty
THE OWNER. H Cl AN13 STATE LAWS REGULATING CONSTRUC�
C YN PERSON WILL BE EMPLOYED
TION; AND IN DOINETHE WORK AUTHORIZED TH 0
IN VIOLATION OF a FRED F WASHINGTON RELATING TO
THE LABOR CODE 0 THE STATE 0
WORKMEN'S COMPENSATION INSURANCE AND ROW 18.27
APPLICATION APPROVAL
the
CAL SIajq oh'�ml d"iah,, oaptay� and F am paid. ad
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FOR INSP TION
OFFICIALS SIGNATURE DATE
SIG,JATUBE'.NER Cclau� OATS SIGfll
Jf
(425)
771 -0220
-LEASEDBY ODTE
MENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS 13EEN GRANTED, UBC SECTION 109
Ex 17333
771-0221
FAX
1
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IIESTID OATS
PLUMBING
MECHANICAL
—70
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINCIPILL
DOMAIN (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
—
SEPARATE PERMISSION'
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STATE SURCHARGE
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT: I YEAR . PROVIDED ORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE A.. 01 PINK Pl.iia"T FOR MORE INFORMATION
ENG. INSPECTION FEE
'A PLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
INPNTEREST. AGREES TO:NDEMNIFY, DEPEND AND HOLD HARMLESS THE CITY F
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EMPLOYEES, AND AGENTS FROM ANY AND
Too
2 EDMONDS, WASHINGTON, TS OFFICIALS,
ALLCLAIMS FOR DAMAGE OFWHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
RECEIP
FROM THE SIUANOI OF T S PERMIT. ISSUANCE OF THIS PERMIT S. LL NOT BE
PLAIN CHECK DEPOSIT
D EMEDTO MODIFY, WAIVE REDUCE ANY REQUIREMENTOF ANY CRYORDINANCS
0 NOR LIMIT IN ANYWAYTHE CITY'S ABILITY TO ENFORCE ANY RDINANCEPROVI$tON."
TOTAL AMOUNT DUE
SIR
oc�
IHERE Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT T11Z INFORMATION
APPLICATION APPROVAL
GIVENS SCORRECT. ANDTHAT I AM THE OWNER, OR T EDULYA THORIZEDAGENTOF
THE OWNER, AGREE To COMPLY WITH CITY AND STATEN LAWS REGULATING CONST2UC-
I
CALL B, d,,g official a, hillhl� DOWY: nd Focii c,apa,dd
TION: AND IN DOING THE WORK AUTHORIZED HEREBY, NO PERSON WILL BE EMP E
STATE OF WASHINGTON REIATI'NOGYTOD
d
FOR INSPECTION
IN VIO OF THE LABOR CODE OF THET
WORKMAETNI�OSNCOMPENSAT!ON INSURANCE AND RCW 18.21.
OFFICIALS SIGNATURE DATE
(425)
I SIGNATURE (OWNER SO In) 771-0220
L cj.. FIELEASEDBY
EXT/333
ATTENTION
IT IS UNLAWFUL TO USE 08 OCCUPY A BUILDING OR STRUCTURE UNTIL
P RTIFI- 771-0221
A FINAL INS ECTION HAS BEEN MADE AND APPROVAL OR A CE ORIGINAL - FILE YELLOW - INSPECTOR�
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK - OWNER GOLD - ASSESSOR