20010546.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
;ER NAMEMAME OF BUSINESS
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NAME
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC
_ , , , . , I,
DGMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT APPLICATION: IBD DAYS
PERMIT LIMIT: I YEAR - PROVIDED WORK'S STARTED WITHIN 180 DAYS
END REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMAT10N
P ICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SU C E5OR$
-AP L
END. INSPECTION FEE
IN I NTEREST. AGREES TO INDEMNIFY DEFEND AND HOLD HARMLESS 7 F CITY OF
7—NDSCAPING
a EDMONDS, WASHINGTON. ITSOIFICIALS. EMPLOYEES. ANCAGENTS FROM ANY AND
ALLCLAIMS FOR DAMAGESOF WHATEVER NATURE. ARISING DIRECTLYOR INDIRECTLY
INSPECTION FEE
RECEIPT
.1 FR I THE ISSUANCE 01 '"IS PERMIT ISSUANCE 01 THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
P ITANLI,
DEoE EANY REQUIREMENT OF ANY ORDINAN E
MED TO MODIFY. WAIVE OR REOUC CITY
D NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE TH H E READ THIS APPLICATION; THAT THE INFORMATION
AV
APPLICATION
APPROVAL
GIVEN IS CORRECT. AND TH T AM THE OVVNER� OR THE DULY AUTHORIZED AGENT OF
AT:
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Thl, IPPI-Ilt'l- 11 "1 , poj lbI 1�pld by ih,
III OWNER I A6R E To CoM LY WITH CITY AND STATE LAWS REGULATING CONSTRUC
CALL
Bulldl�o oll,l ., hW Dt, �d F
_U , G._!,.E W.R� AUTHORIZE. IHERE.Y. NO PERSON WILL BE LEMPLOYTED
CODE OF THE STATE OF WASHINGTON RE ATIN. o
P
R INSPECTION ,p� 1,1,,d,n ... pmidod.
I I !SURANCE AND FCW 19.27
OFF IIA
(425)
JDAIESIGNED
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771-0220
RE E EDBY DATE
A
EXT 1333
0/
I EOROCC PYA BUILDING OR STRUCTURE UNTIL
T7�TWFVTO us U
771-0221
—
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
7 ORIGINAL -FILE - YELLOW -INSPECTOR x
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109
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REMARKS
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DESCRIBE WORK TO BE DONE
REMARKS
INSPECTIONS PER UBC 10811FINAL INSPECTION REQ-1319
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PROGRESS
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CHECK NO:
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VESTED DATE
PLUMBING
MECHANICAL
m THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t:1 BE DONE ON PRSIVATF PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
DOMAIN ..B . SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT APPLICATION: 180 DAYS
P KI
PERMIT LIMIT. I YEAR - ROVIDED WOR S STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
RM
SEE SACK OF FINK PERMIT FOR MORE INFORM ION
ON BEHALF OF HIS OR HER SPOUSE, 8EIREL AS AND SUCCESORS
ENG. INSPECTION FEE
;APPLICANT.
N INTEREST. AGREES TO INDEMNIFY. DEPEND AND HOLD - � ESS THE CITY OF
LANDSCAPING
I
1
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANYAND
ALLCLAIMSFOR DAMAGES OF WHATEVER NATURE.ARISING DIFE-1-1--l—I
INSPECTION FEE
RECEIPT
FA M THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
0
PLAN CHECK DEPOSIT
5
Y CE
DEEMEDTO MODIFY.WAIVE OR REDUCE ANY REQUIREMENT OF ANY CIT OBDINAN .
I
.9
NOR LIMIT IN ANY WAYTHE CITY'S ABILITY TO ENFORCE ANY ORDINANC ISION
TOTAL AMOUNT DUE
AECEIP
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT 01
T is.P111-1- '- - - P-4 u-II -19"-d "y"m
THE OWNER E'OCOM Y WITH CITY AND STATE LAWS REGULATING CONSTRUC
CALL
a O",ciiiiii, hi,fter Deputy:,,d Fees am paid, -a
T �,',A.IGNR.ET.E�..Tl��'T...I��DI.E.�.1-P-Sc���ILLB�LE.PLOY,�D
lom AND
WASHIINGTON RE ATING 0
FOR INSPECTION
mciiipl s,,k,mwI1d90d '—pace pievided
N V1 LATI CODE OF THE STATE OF
18,27.
DAT,�
WORKOMEN I SURANCE AND RCW
(425)
OFF LS SIGNATUR
DATE SIGNED
-7-.")-
L-L�
771-0220
BE DBY DATE
A T'
EXT 1333
Ig
I T7tWFVTo USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
AND APPROVAL OR A CERTIFI-
ORIGINAL -FILE YEIL.—INSPICTCR A
A FINAL INSPECTION HAS BEEN MADE
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX PINK - OWNER GOLD - ASSESSOR
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