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US' PERMIT
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NUMBER
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CONSTRUCTION PERMIT APPLICATION JOB SUITEIAITI
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SEPARATE PERMISSION
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PERMIT APPLICATION: 180 DAYS
- '. ORK IMS STARTED WITHIN 1 8D DAYS
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PERMIT LIMIT. I YEA.
ENG. REVIEW FEES
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0 NOR U MIT IN ANY WAY THE CITY'S ABILI TY TO ENFORCE ANY ORDINANCE PAOIISION.
TOTAL AMOUNT DUE
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I HEREBY ACKNOWLEDGE THAT I HAVTE READ APPIICEATI�OLNY THAT THE NF F.ATICN
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IN VIOLATION OF THE LABOR CODE OF THE STATE OF
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OF ICIALS SIGNA RE DATE
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771-0220
ELEASED BY DATE
EXT 333
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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
ASSESSOR
A FINAL
CATE OF OCCUPANCY HAS BEEN GRANTED . UBC SECTION 109
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'DATE RECEIVED _ERMITEXPIRES
p
USE
"E PERMIT 201 rmw
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CITY OF EDMONDS �1114E PS-F) NUMBER
JOB SUITEIAPT.
CONSTRUCTION PERMIT APPLICATION ADDRESS ? 38 -7Hqll *t
OWNERNAMENAMEOF USINESS RCL
PLAT NAM?EISUBOIVISION NO. LOT NO LID NO.
PLAT;
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THIS PERMIT AUTI-II)RIZES ONLY 'HE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
MECHANICAL
GRADINGdFILL
DOMAIN (CURBS, SIDE WALKS, DRIVEWAYS. MAPQUEES�ETC.) REGY RE
.�ILL
I SEPARATE PERMISSION.
STATE SURCHARGE
MIT APPLICATION: ISO DAYS
g. PERMIT LIMIT. I YEARE ! PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
.. I I �l
to 'APPLICA NIE LF11 Eg,,IF.,ER FpErUSEXNHDEtjRS. ASSIGNS AND SUCCESDRS
to " N T.,ND .� 4 IMD HARMLESS THE CITY OF
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LANDSGAP NG
IN HT..Ef
EDMONDS. WASHINGTON. ITS OFFICIALS EMPLOYEES TS FROM ANY AND
3 'u"HATEE4NATU.E, Anu�ANB AG�N
AULCLAIMSFOR DA AGEt ING DIRECTLYOR INDIRECTLY
INSPECTION FEE
RECEIPT
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY. WAIV EORREDUCEANY EQUIREMENTOFANY CITY ORDINANCE
RE
PLAN CHECK DEPOSIT
0 NOR LIMIT IN ANY WAYTHE CITY'S A LITYTO NFORCE ANY ORDINANCE PROVISION.'
SI
RECEI PT
TOTAL AMOUNT DUE -1
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPT;CAT,�0LN, T
�AHATT IENllIll.ATI N
. , ENTOF
UTHB�E
LICATIO?i APPROVAL
AM THE OWNER n .
GIVEN IS COPPED - AND THAT I ATE LAWS REGULATING CONSTRUC.
THE OWNEII* I ASRE E To COMPLY WITH CITY AN62T
CALL Bu The ppticalm, I, not , permit U. I"
rt Fee. .. 1.4 end
Mirg Ofti,i,l or hi,ftr Deputy: out
TION� AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
STATE OF WASHINGTON RELATING TO
FOR INSPECTION Wpt 1, ,k,owl,dg,d P.co proided.
IN VIOLATION OF THE LABOR C BE OF THE
KME GO PENSATION INSURANCE AND RCW 18 -
Won N'S M .27.
DATE
OF ICIALS S�G&r
GNATURE (OWNER ATE SIGNED
(425)
6A
� �ENT) 00
-022 DATE
71 LEASED BY
7 0
EXT 333
ATTENTION
IT IS UNLAWFUL To USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTIO N 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