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PERMIT EXPIRES
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SEPARATE PERMISSION.
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PERMITAPPUCATI N: ISO DAYS
PERMIT UNIT. 1 YEAR - PROVIDED WORK IMS STARTED WITHIN 100 DAYS
ENG, REVIEW FEES
SEE BACK OF PINK PERMIT FOR OREINFORMATION
*APPLICA�TIOAN.EENALF F HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
N I I A REES T INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
I HTERES R EST
ANY AND
LANDSCAPING
EDMONDS.WA HING' i I OFFICIALS. EMPLOYEES, AND AGENTS FROM
Es FWHATEVER NATURE. ARISING DIRECTLYOR INDIRECTLY
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FROM THE ISSUANCE OF IN" PERMIT. ISSUANCE OF THIS PERMIT SHALL N07 BE
PLAN CHECK DEPOSIT
PLAN CHECK DE PO"T
0 EM ...... IFY AIV. OR REDUCE ANY REQUIREMENT OF ANYCITY ORDINANCE
NOR LIMIT IN ANY Why THE CITY'S ABILITYTO ENFORCE ANY ORDINANCE PROVISION
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPTICATION. THAT THE INFORMATION
OWEN 15 CORRECT. AND THAT I AM THE OWNER. OR HE DULY AUTHORIZED AGENT OF
THEOWNER IAGREETO COMPLY WITH CITY AND STATE LOAWS REGULATING CONSTRUC.
CALL
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TION, AND IN DOING THE WORK AUTHORIZED THEREBY. N PERSON WILL BE EMPLOYED
OF THE STATE OF WASHINGTON RELATING TO
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FOR INSPECTION
IN VI CODE
WOE��UFIAACE AND FICW I. "
SIGNED
(425)
71-0220
7 1 _0 0
ATTENTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
VALUATION
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("T
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D CHANGE OF USE
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REGO I PROVIDED
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REMARKS
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BE DONE ON PFJIVAT�, PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC
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DOMAIN (CURDS, SIDEWALKS, DRIVEWAYS , MARQUEES, ETC.) WILL REQUIRE
H A H - E
STATE SURCHARGE
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SEPARATE PERMISSION.
PERMIT APPLICATION: ISO DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STA TED WITHIN ISO DAYS
E E ES
ENG. REVIEW FEES
N R E W
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
V
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12 ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSI GNS AND SUCCESORS
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DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENTOF ANYCITY ORDINANCE
0 NOR LIMIT IN ANY WAYTHE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION!
TOTAL AMOUNT DUE
IHEREB ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INF AMATION
GIVEN ly CORRECT. AND THAT I AM THE OWNER. OR THE IXILY AUTHORIZED AGENT OF
S
G UC
THEOWNER. I AGREE To COMPLY WITH CITY AND STATE LAWS REGULATIN CONSTRUC-
CALL
TiON. AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
To
OF WASHINGTO RELAT NG TO
N I 'y
S P TIC
FOR INSPECTION
FOR IN Ec
CODE
1.4 VIOLAT OF THE STATE
"'It E
K.EN:,N!� CE AND RCW 18-27.
WOR O�PE �SATIONR URAN
DATE SIGNED
_!�TU OWN�ERORAG!!�� '7-6-01
(425)
771-0220
ATTENTION
EXT 1333
IT 15 UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
VALUATION I FEE
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