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SEPARATE PEA�ISSION- —
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PERMIT APPLICATION: 160DAYS
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MIT I. T y -A.
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
BE K OF
ENG. REVIEW FEES
;APPLICANT ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
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2 EDMONDS� WASHINGTON, TS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANIAND
EDMONDS WASHINGTON I
I ALLCLAIMS FOR DAMAGESOFWHATEVER NATURE� ARISING DIRE, ILI — I—— I
ALLC".S,OR.AMAGE. I
I FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE
'... THE ISSUANCE ", ,
CI DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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a NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISIOW'
NOR LMTH ANY WAY HE ,
ENG, INSPECTION FEE
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TOTAL AMOUNT DUE
RECEIPT
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT Or
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTnUC.
TION;AND,IND ING THE WORK AUTHORIZED THEREBY. No PERSON WILL BE EMPLOYED
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N VtOLAT ON OF THE LABOR CODE OF THE STATE OF WASHINGTON RE ATING TO
WORKMEN'S C=ON INSURANCE AN CWIS27�
APPLICATION APPROVAL
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771-0220
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EASED By DATE
ENITION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109
EXT 333
771-0221
FAX
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PINK - OWNER GOLD - ASSESSOR
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US, PERMIT
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CITY OF EDMONDS
UMBER201
CONSTRUCTION PERMIT APPLICATION
JOB
SUITEIAPT.
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VNEA NAMENAME OF BUSIIV�
PLAT NAMEISUBDIVISION NO.
LCENO. UD NO.
LID FEE $
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LY ANYC NS�IRSUpERMNJTOCHOTVHEEf�SWO�KTO
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SEPARATE PERMISSION,
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SEE BACK OP PINK P..IT VP MORE .1.FMATlqp_
'APPLICANT, ON BEHAL F HIS OR HER SPOUSE, HEIRS, ASSIGNS,AZ SUCCES085
bh.. t ... — PON FEE
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
ANY AND
-dAW0SDAPMM'
OFFICIALS, EMPLOYEES. AND AGENTS FROM
EDMONDS WASHING MIT H 6 INDIRECTLY
C TGE FW ATEVER NATURE, ARISING
ALLCLAIM�FOFI AMI P, NOT BE
IN8P`ffC"eN+fiE--
—1-1
RECEIPT
SIQE�,CTLYOR
1. FROM THE ISSUANCE OF THI PERMIT ISE AN�' OF THI MIT SHALL
DEEMEDTO MODIFY, WAIVE OR REDUCE ANY REQUIREMENTOF ANY CITY ORDINANCE
CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION
PLAN CHECK DEPOSIT
RECE P
Y
0 NORLIMITINAN WAYTHE
.1 - -
To TAL AMOUNT DUE
If I - , 11
I HERE Y ACK14OWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE OULY AUTHORIZED AGENT OF
Th I. ep"u-n 1. net . �ohbjj until signed by the
T NGE ULA
HE OWNER. I AGREE TO COMPLY WITH CITY TATE LAW.-E. T"`-C E ' P TRUE.
A M L-Y
.. EBY No PERSON WILL BE
CALL
IdjbqOIIi,.;b, b,eb,D.Fby:..dF.....p.id,uhd
Sul in
TION; AND 0 WORK AUTHORIZED T .
0 ING THE E STATE OF WASHINGTON RELATING To
OF THE LABOR CODE OF TH
FOR INSPECTION be olpt i—keml,dgedil SP110 Pmidcd
'IN
IN VIOLAT ON
ORKMEN'S ATO INSURANCE AND RCW 18,27.
FFICIALSSIGNAT E DATE
SIGNATUR Q A F T) E SIGNED
(425)
/11 2 2. oej)
771-0220
F,EASED BY
ATTENTION
EXT 333�
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNT11
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIF
-
ORIGINAL - FILE YELLOW INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER GOLD � ASSESSOR