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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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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
GRADINGIFILL
DOMAIN (CURBS, AYS, MARQUEES. ETC.) WILL REQUIRE
SIDEWALKS. DRIVEW
STATE SURCHARGE
SEPARATE PERMISSION,
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT'. I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
ENG, REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
P ON BEHALF OF MIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
;SIGNER(425)
SING. INSPECTION FEE
;APLICANT.
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N INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HAR.LE S THE CITY OF
EDMONDS. WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
ALLCLAIMSFOR AMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
BE
FROM THE ISSUANCE OF THI I, PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT
PLAN CHECK DEPOSIT
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DEEMEOTOMODIFY. WAIIEOR REDUCE ANY REQUIREMENTOF ANYC TYORDINANCE -
0 .�LIMITMINANY.T.EIITY�A.ILITYT..NF.R�EANY.�.INAN�E
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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 COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
TION: AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
OF WASHINGTON RELATING TO
FOR INSPECTII
IN VIOLATION OF THE LABOR CODE OF THE STATE
WORKMEN'S COIAPENSATI=INSURANCE AND HCW 18.21
-SIGNATURE eVr DATE
(OWNER AGENT
75-k.
771-0220
EXT/333
ATTENTION
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. USC SECTION 109
FAX
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VALUATION I FEE
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FINAL PROJECI APPROVAL FORM
TO:
DATE,
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: --FIRE DEPARTMENT DATE_-/_(___1—_1--ff-'J
GINEERING DIVISION DATE,�_
PLANNING DIVISION D
PROM _�At rri4-
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PERMIT 0 o 90 —ADB#_DATE INSPECTED -
DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine compliance with approved plans. Final approval, denotes that
there are no objections from the above signed Department to the granting of
inal approval of the described work
rmance.Bonds associated with the project may be released
GRANT FINAL PROJECT APPROVAL
____�GRANT FINAL PROJECT APPROVAL WITH CONDITIONS NOTED
AILED FINAL INSPECTION -OUTSTANDING ISSUES
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�VESTED DATE
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THIS PERMIT AUTHORIZES ..Ll THE WORKN.T B. THIS PERMIT COVERS WORK TO
MECHANICAL
E B.HE . PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
DOMAIN (CURBS, SIDE ALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION .
STATE SURCHARGE
PERMIT APPLICATION;, 180 DAYS
PERMIT LIMIT. I YEAR � PROVIDE. WORK 5 STARTED WITHIN I 8D DAYS
ENS. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MoSe INFORMATION
ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
W.i_
9 G. INSPECTION FEE
;APPLICANT.
N INTEREST. AGREES TO:NDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
FROM ANY AND
EDMONDS , WASHINGTON, TS OFFICIALS. EMPLOYEES. AND AGENTS
ALLCLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
INSP E
RECEIPT
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
ANY ORDINANC E P ROVISION.'
RE EIPT
L4S
0 NOR LIMIT IN ANY WAY TH E CITY'S ABILITY TO ENFORCE
—
TOTAL AMOUNT DUE
I HEREBY ACKIOWLEIGE THAT I HAVE READ THIS APPLICATION� THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
.I , p—t �ltlt ligIld by th,
TH5OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
CALL
D.ouly:.�dF... — P�,,L
TION: AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOY TED
OF WASHINGTON RELATING 0
FOR INSPECTION .pt I—k—Ildged �� space providod
IN VIOLATION OF THE LABOR CODE OF THE STATE
WORKMEN'S COMPENSATIO I SURANCE AND RCW 18,21.
FIC[ALS StGNAT R
8 =DATE SIGNED
(425)SIGNATURE
(OWNER 0 AGENIVFi"g
7""
771-0220
( k
/,;Z, a,6,L, L. j��
REL AS5D BY DA E
ATTENTION
EXT/333
IT IS UNLAWFULTO USE OR OCCUPY A BUILDING OR SIRUCTURE UNTIL
HAS BEEN MADE AND APPROVAL OR A CERTIFI-
771-0221
ORIGiNAL-FILE YELLOW -INSPECTOR
A FINAL INSPECTION
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER GOLD - ASSESSOR
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