20000932.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PLAN CHECK FEE
VALUATION
FEE
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTEM THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
DOMAIN (CUA9S, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
STATE SURCHARGE
PE "MITAPPUCATION 180-AYS
PERMIT LIMIT'. I YEAR, PROVIDED OAK IS STA TED WITHIN 180 DAYS
ENG, REVI FEES
SEEBACK OF PINK PERMIT FOR MORE INFORMATION
-APPLICANT ON BEHALF OF HIS OR HER SPOUSE, HEMS. A SIGNS AND SUCCESORS
THE CITY OF
EI,IG, INSPECTION FEE
IN INTEREST, AGREES TO :NDEMNIFY� DEFEND AND HOLD HARMLESS
AND AGENTS FROM ANY AND
_t*NVS,,MG
I EDMONDS, WASHINGTO TS OFFICIALS. EMPLOYEES.
1. A`LCU"MS FOR DAMAGNEE OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
OF THIS PERMIT SHALL HOT BE
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CHECK DEPOSIT
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I FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE
DEEMEDTO MODIFY. WAIVE A REDUCE ANY REQUIREMENT OF ANY CIT ORDINANCE
PLAN
RECEIPT
OR LIMIT IN ANYWAY THE CITY'S AS ILITYTO ENFORCE ANYORDINAN
TOTAL AMOUNT DUE
I jEpEBY ACKNOWLEDGE TH I HAVE READ THIS APPLICATION: THAT THE IN5ORNIATION
APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER, ORATTEE DUSLy AUTHGRI'�.ED AGENT I
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Ti,EOWNER. IAGREETOC ST LAW RE, U, NETRUC-
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CALL
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TION; AND IN DOING THE WORK AUTHORIZE RELATING To
FOR INSPECTION recoipt is acknowled g
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON
7.
,�WANO RCW 18.
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(425)
771-0220
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IT IS UNLAWFUL TO USE 08 OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL -FILE YELLOW - INSPECTOR
PINK � OWNER GOLD - ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
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t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUSUC
DOMAIN (CURDS, SIDEWA Wag WILL E.Ul..
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PERMIT LIMIT. I YEAR PROVIDED WORK IS
SEEBACK OF PINK PERMIT FOR MORE INFORMATION
SOR POUSG. HEIRS� ASSIGNS AND SUCC5SORS
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ENG. INSPECTION �EE
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ST To S OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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FOR DAMAGES
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PLAN CHECK DEPOSIT
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To
cl DEEMED.TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
LIMIT 1. ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION,'
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10,
TOTAL AMOUNT DUE,
I E.-GY ACKNOWLEDGE THAT I HAVE DEAD THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
IS RUC*
I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONST
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off I., hi,ft, Depty: and
NER
THE OW E
EMP Loy 0
AND,IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE I
OF THE I ABOR CODE OF THE STATE OF WASHINGTON RELATIN TO
FOR INSPECTION
BL', all,
.�k-I.Vig.d �a ap... p-la.d.
OLAT
WORK E, OMP Ns INSUR�NCFAND PCW H3.27, 0 IGIALS SIGNATURE
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_-Zl- i � z-
4YTENTION EXT 3
IT IS U NLAWFUL TO U BE 0 R OCCUPY A BU I L.1 NG OR STRUCTUR E U NTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL�FILE YELLOW -INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 'FAX PINK . OWNER GOLD � ASSESSOR