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CITY OF EDMONDS
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PERMIT LIMI� I YEAR - ROVIDED WORK IS STARTED WITHIN 18D DAYS
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771-0220
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IT IS UNLAWFUL TO USE OR O.0 lY A BUILDING OR STRUCTURE UNTIL
771-0221
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL � FILE YELLOW INSPECTOR
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Slab Insulation ..........
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Commercial Flnal
HEATING:
Gas Test ....................
Gas Piping .................
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Equipment ..............
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NAILING ..........................
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Ceiling Insulation
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PROGRESS INSPECTIONS PER UBC 1108/FINAI IN'
DEEMEDTOMODFY
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VALUATION
FEE
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LOT SLOPE %
HEAT SOURCE GLAZIN 3 1
BUILDING
rESTED DATE
LAN CHECK NO: (y�
PLUMBING
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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
GRAOING/FILL
2 DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.1 WILL REQUIRE
m PERMISSION.
SEPARATE
STATE SURCHARGE
PERMIT APPLICATI
PERMIT LIMIT. I YEAR � PROVIDED WORK IS STARTED WITHIN 180 DAYS
E�
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ON BEHALF OF HIS OR HER SPOUSE. HEINS. ASSIGNS AND SUCGESORS
ENG. INSPECTION FEE
;APPLICANT,
N INTEREST. AGREES TO INDEMNIFY DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
2 EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES. ANO AGENTS FROM A.YAND
C F WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
M�S FO'DAMAGESO
INSPECTION FEE
5 A L L LA
FROM T II�UANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
EPOSIT
PLAN CHECK DEPOSIT
NOR LIMIT IN AN' WAY THE CITY'S ABILITY To ENFORCE ANY ORDINANCE PROVISION.-
H OPT
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
IS CORRECT. AND T I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
`AP�PILIC(ATION APPROVAL
Thl. M - - I—Il `1 �zll 11 Ih,
GIVEN
THE OWNER, I AGREE TO CHAT WITH CITY AND STATE LAWS REGULATING CONSTRUG
OMPLY
CALL
BlddlIg Offictal , 1,101,11 DOPUtY. ... .. P.0—d
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, No PERSON WILL BE EMPLOYED
bF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
,,,,pt I, ..k..Ildg.d I, p-8 plov,dod.
IN VIOLATION OF THE LABOR CODE
WORAMEN'S COMPENSr RANGE AND ACW 18. 7.
IFFICIA 11 ATU
__7
DATE SIGNED
(425)
771-0220
AEUEA w D ATt
EXT 333
(�A I _21d L"
- ('X
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
/
NSPECTO.
A FINAL FE ND APPROVAL 08 A CERTiFl-
INS CTION HAS BEEN MADE A
ORIGINAL -FILE Y "LOW *�' S.SOR
wR GOLD - A
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109
FAX
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