20000982A.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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STATE SURCHARGE
PERMIT APPLICATION: 10 DAYS
YE THIN loo DAYS
PERMITLIMIT.1 AS � PROVIDED WORK IS STARTED W
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
THE CITY OF
. INSPECTIO*
;APPLICANT.
DEFEND AND HOLD HARMLESS
N INTEREST, AGREES TO INDEMNIFY. EMPLOY AGENTS FROM ANY AND
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ALLGI-AIMS FOR DAMAGES OF WHATEVER NATURE� ARISING DIRECTLYOR INDIRECTLY
THIS PERMIT SHALL NOT BE
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DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT Or ANY CITY ORDINANCE
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—7.
IHEREB ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I A. THE OWNER, 08 THE DULY AUTHORIZED AGENT OF
STATE LAWS REGULATING GO NSTRUC-
CALL
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THE OW'M I AGREE TO COMPLY WITH CITY AND
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IN VIOLATION D� MrTAvort CODE OF THE STATE WASHt
DATE
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OFFICIALS SIGNATURE
DATE SIGNED
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771-0220
RELEASEDBY DATE
7FENTION
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL -FILE - YELLOW -INSPECTOR
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ENGINEERING DIVISION DATE--I�
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FINAL PROJECT APPROVAL
PROJECT APPROVAL WITH CONDITIONS NOTED
FAILED FINAL INSPECTION OUTSTANDING ISSUES
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'DATE F CEIVAO
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USE
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CITY OF EDMONDS ZONE
NUMBER
CONSTRUCTION PERMIT APPLICATION 'A005DRESS
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OWNERNAMENAME OF SUSI EBB
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PER MIT APPLICATION: 180 DAYS
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SEE BACK OF PINK PERMIT FOR MORE INFORMATION
0 E
INSPECTION
-APPLICANT. ON BEHALF F "IS OR HER SPC USE, HEIRS. ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO IN,,M111Y EIENO AN. ..LG HARMLESS T. CITY OF
ENTSFROM ANYAND
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ISSUANCE 01ITIHIT11 .IC,T�Y.A.LL.NOT BE PLAN ..-K DEPOSIT /so —
FROM THE ISSUANCE OP THIS PERMIT N UFS. Or F
ANY
DEEMEDTO MODIFY, WAVE OR REDUCE ANY E INANCE
CEANYO DINANCE PROVISION., RECE
NOR LIMIT IN ANY WAY THE CITY$ ABILITY TO ENFOR 1 —7.
TOTAL AMOUNT DUE,
—Ac��--U�T U
I HAVE READ THIS APPLICATION, THAT THE INFORMATION APPLICATION APPROVAL
I�NIHIEGY LSDON"ATT, 'Y mp.� �y
"EN , =TAN.T.A AMTHEOWNER,ORTHEDLl AUTHORIZE. AGENT 01 Thil 1PRIC.1ill 11 1-t A P-4 unt"
B"I D. ,:..dF...,A.P.,d—d
'THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC CALL d119 Offill.!,lhlslh. PudjF.FAR, plAli—,
TION; AND IN DOING THE WORK AUTH ED THE By, N PER 0 WILL BE EMPLOYED '11"Pt `"`H�dg
. GO ORIZ RE WASHSI GT FOR
IN VIOLATION OF�THE BE OF THE STATE OFO NN ON RELATING TO INSPECT ON
WOR S - �LT4AO R OATS
KMEN' COMPEN I N NSq=ND CW 18,21. OFFICIALS SIGNATURE
(425)
GAII 00 771 m0220 REL5ASEDBY DATE
ATTENTION EXT 333
ITISUNL FUL TO USE On OCCUPY A BUILDING OR STRUCTURE UNTIL 1-0221
A FINAL IANWSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- 771 ORIGINAL FILE YELLOW - INSPECT R
PINK�OWAER GOLD -ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109 FAX