20010287.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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9' DoN' oNPR"ATE RWAoL'KS. WILL REQUIRE
RA.ING11ILL
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A"' '"R.S.SD SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT APPLICATION: 180 DAYS
PROVIDED WORK STARTED WITHIN 180 DAYS
IS
END REVIEW FEES
PERMIT LIMIT: I YEAR '
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
LI.C.A.N.T� E All OF HIS OR HER SPOUSE. NEM.S. ABSI.NS AND SUCCESORS
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BE
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ORDINANCE
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ORDINANCE PROVISION.�
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TOTAL AMOUNT DUE
THAT I HAVE READ THIS APITLI.CEATI�ONy THAI THE IN' RMATI-1
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OR" T NO CONSTRUC-
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'N V-oLAT,oN OF T"E LA.- CODE OF THE STATE OF WASHINGTON RELATING To
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IT IS UNLAWFUL
HAS BEEN MADE AND APPROVALaR A CERTIFi-
IG�I L - FILE YElO.
GOLD AS ESSOR
A FINAL INSPECTION
GRANTED. UBC SECTION 109
FAX
PINK -OWNER
CATE OF OCCUPANCY HAS BEEN
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VALUATION FEE
PLAN CHECK FEE
HEAT SOURCE
LOT 110111
BUILDING
PLAN CHECK NO:
ED DATE
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK To
BE .. C N PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
..AN CDFGS� SIDEWALKS , DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION
STATE SURCHARGE
P RMIT APPLICATION: IDD DAYS,
E
P K I
PERMIT LIMIT. I YEAR . ROVIDED WOR S STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEC BACK OF PINK PERMIT FOR MORE INFO MATION
ENG. INSPECTION FEE
ON BEHALF OF HIS OR HER SPOUSE, HERE. ASSIGNS AND SUCCESORS
;APPLICANT.
N INTCREST AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
EDMONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANYAND
INSPECTION FEE
OFW ATEVERN URE.AFtiStNODIR5CTLYORINL)IRECTLY
IPT
3 PERMIT SHALL NOT BE
PLAIN CHECK DEPOSIT
OF ANY CITY ORDINANCE
ORDINANCE PROVISION.'
T)
TOTAL AMOUNT DUE
_IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CDR FCT. AND THAT I AM THE OWNS F' OR THE DULY AUTHORIZED AGENT OF
`AGPEE
Ithil Ippil"Ill - 11 "It I PGIM!t �nlllF.19 Y In.
TO COMPLY WITH CITY AND COLLATING CONSTRUC-
HE NER. I STATE LAWS R
T OW
CALL
Etnj d,,g O[f,,I.IhIa/hll D,pUty: and 10,111pald.—
TtON: AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
TO
FOR INSPECTION
11111PI I, "k—ladpa 1, 11 pl—ced.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING
WORKMEN'S COMPENSATI INSURANCE AND ROW 18.21,
071-1cly-f:p-1
ATE SIGNED
(425
771-0220
—RELEASE
EXT 1333
v o
UNLAWFULTO USE OR OCCUPY ABUILDING 08 STRUCTURE UNTIL
771-0221
.
/
IT IS
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL ORJA CERTIFI-
GINAL-FILE YELLOW SPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBCSECTION 09
FAX
PINK -OWNER COLD ASSESSOR , J
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