20010558.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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REMARKS
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VALUATION PEE
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PERMIT LIMIT. 1 YEAR , PROVIDED WORK IS STARTED WITHIN 100 DAYS
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SEE BACK OF
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I A PLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
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END INSPECTION FEE
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1 HERE$ ACKNOWLEDGE THAT I HAVE P1A.T.IS APPLICATION THAT THE 11,1FORMAT ON
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GIVEN IS CORRECT. AND THAT I AM THE OWNER OR THE OLLY AUTHORIZED AGENT OF
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THEOWNER I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONETRUC-
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CALL
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AND IN DOING THE WORK AUTHORIZED THEREBY NO 'EPSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
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INORKMENS3��"SATION INSURANCE AND RCW 18 27
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771-0221
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ORIGINAL - FILE - YELLOW - INSPECTOR
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Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
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SHEETROCK NAILING
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SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
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CITY OF EDMOND
CONSTRUCTION PERMIT APPLICATION
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ENG. REVIEW FEES
SEE BACK ot; PINK PERMIT FOR MORE INFORMATION
ING. INSPECTION FEE
P PLICANTONBEHAL OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORIS
;A MLESS THE CITY OF
N NTEREST. AGREES TO :ND MNIFY, DEFEND AND HOLD PAR
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HOF L .. T I N A YW�YT.E.ITY� ABILITY TG ENFORCE ANY ORDINANCE PROVISION.
IR 71V/0
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLI ATION APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
This IPPICIIS is It I pellit I.Ilt sighed by the
THEOWNER. I AGREETOCOMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
WILL BE EMPLOYED
CALL
B111-D Offill.1 of hishel Deputy: led Fee, — PlId. Ild
TION; AND IN GOING THE WORK AUTHORIZED THEREBY. NO PERSON
WASHINGTON RELATING TO
FOR INSPECTION —PI is 11showledged space p,d,d
IN VIOLATION OF THE LABOR CODE OF THE STATE OF
WORKMEN =SATION INSURANCE AND RCW 18.27.
OFFICIALS St TURE
DATE SIGNED
(425)
_4112
771-0220
RlllAlEQ BY I CATE
ATTEATIOIC
EXT I 3d3
ITS UNLAWFULTOUSEOR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
'1 -
A FINAL NSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI.
ORIGINAL - FILE YELLOW - INSPECTOR
CATE OFIOCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER GOLD - ASSESSOR
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