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CITY 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 CONST UCTION ON THE PUBLIC
E DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
GRADINGWILL
SEPARATE PERMISSION.
PERMIT APPLICATIO : 100 04YS
YEAR � PROVID D WORK IS STARTED WITHIN 180 DAYS
PERMIT ILIMIt I E
E... FVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ON BEHALF OF HIS OR HER SPOUSE. H51PS. ASSIGNS AND SUCCESORS
ENO, INSPECTION FEE
;APPLICANT
N INTER ST, AGREES TO:ND MNIrY. DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
a EDMONDE SHINGTON. TS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
X Si WAS DAMAGESOF WHATEVER NATUR IRE
ALLCI.AIMSFO E, ARISING OtRECTLYOR IND CTLY
INSPECTION FEE
RECEIPT
I FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SH ILL NOT BE
PLAN CHECK DEPOSIT
. DEEMED TO MODIFY. WAIVE OR REDUCE ANY FISQUIREMENTOF ANY CITY ORDINANCE
ol NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISIO-
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T TALAMOUNT DUE
'%-�-YACKN-WLE ET -AT: HAVE READ THIS APPLICATION; THAT THE INFORmAi [ON
APPLICATION
APPROVAL
GIVEN ,CGRECT AT. THAT A. THE OWNER, G IF OLLY AUTHORIZED AGENT OF
LAWS REGULAT�Nc' C.NSTRUC.
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TH"W"E' 'A' E TO COMPLY WITH CITY AND STATE
AUTHORIZE. THER.1 NO PERSON WILL BE EMP DYED
CALL
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OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING To
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WORKME SATIONINSURANC ANORCW18.27,
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ATTENTION
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IT IS UNLAWFUL TO USE 08 OCCUPY A BUILDING OR STRUCTURE UNTIL
If
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL FILE YELLOW - INSPECTOR
A FINAL
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109
FAX
PINK - OWNER GOLD - ASSESSOR
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A-request for odificsA6 variance or other
ady inistrative deviation (hereinafter "variance)
must,he specifically called out and identified.
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Approval of any plat or plan containing
provisions which do not comply with city code
and for which 'a variance has not been
specifically identified, requested and considered
by the appropriate city oflicial in accordance
with the appropriate provision of city code or
state law does not approve any items not to code
specification.
C,!TY OF E F,, .'6i 0 N E-�
LNT7BU�J_DING DEPAPITUIENT
WORK POPQ—
RECEIVED
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OCT 2 6 2000
DEVELOPMENT SERVICES CTR,
CITY OF EDMONDS
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NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB
ADDRESS
SUITEIAFTI
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PILAT NAMEiSUBDIVISION NO.
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NO ADDRESS
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CITY PHO14E
NAME
ENGINEERING 1'�Il DIDATE
ADDRESS
FIRE REVIEWED BY DATE
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PLAN CHECK FEE
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK 1.
t BE DONE ON PRIVATE PROPER" ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADtNGIFILL
2 a OMAIN (CURBS, SIDEWAL.9% DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
t SEPARATE PERMISSION.
ACHARGE
a —PERMIT APPLICATION: ISO DAYS
PERMIT LIMIt I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENO, VIEW FEES
SEE BACK 01 PINK PERMIT FOR MORE INFORMATION
*APPLICANT ON 11HAL OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUOGIIIIRS
ENG. INSPECTION FEE
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
WASHINGTON, ITSOIFIOIALS. EMPLOYEES, AND AGENTS FROM ANY AND
LANDSCAPING
INSPECTION FEE
EDMONDS,
ALLCLAIMS FOR DAMAGESOF WHATEVER NATURE. ARISING DIRECTLYORINDIRECTLY
RECEIPT
FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE
CITY OPOINANCI
PLAN CHECK DEPOSIT
DEEMEDTO MODIFY, WAIVE OR REDUCE ANY PIQUIREMENT 01 ANY
ORLI.ITINANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.
RECEI T
I HERESY THAT � HAVE R�A. THIS APPLICATION; T.A-T THE S,,FC..ATION
APPLICATION:APPROVAL
GIVEN CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
T, J�,jm,,t abl"alli 11911d by Sm
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL Suj��Sgs I 'hi opul,land Fhas arm Paid, 11
TIOR AND IN GOING THE WORK AUTHORIZED THERIBY, NO PERSON WILL BE EMPLOYE
OF THE LABOR CODE OF THE STATE OF WASHING TON RELATING TO
FOR INSPEC TION -,apt Is a.knowl.dg.da, spa. P1.1kad.
IN VIOLATION
WORKMEN'S C0_MkBNlATION INSURANCE AND RCW 18.27,
0 ICIA�S SIGNATUR DATE
(425) 1
771-0220 LEASED BY DATE
ATTENTION
EXT/333 /,z
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
77t-vr_�]
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL FILER YELLOW - INSPECTO
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX PINK . OWNE GOLD -ASSESSOR
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