20010795.pdfDAII HIC11110
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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L BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBUC GRADING"ILL
M DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REOUIRe
SEPARATE PERMISSION. SjAIE-91JRCHARGE
PERMIT APPLICATION: 100 DAYS
PERMIT LIMIT.- I YEAR - PROVIDED WORK 15 STARTED WITHIN 160 DAYS ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENG. INSPECTION FEE
'A LICANT. ON BEHAL F His OR HER SPOUSE. HEIRS, ASS[
IN INTEREST. AGREES T :NOEMNIFY. DEFEND AND HOLD HARMLESS THE CITY Or LANDSCAPING
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EDMONDS. WASHINGTON. T OFFICIALS. EMPLOYEES. AND AGENTS FROM A YAND INSPECTION FEE
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ALL CI.AIMS FOR DAMAGESOF WHATEVER NATURE. ARISING DIRECTLY 04 INOIR RECEIPT
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT
DEEMEOTO MODIFY, WAIV5 OR REDUCEANY REQUIREMENT OF ANYCI rYORDINANCE -
TOENFORCE ANYORDINANCE PROV15ION IF CEIPT
NOR LIMITIN ANY WAYTHE CITY SABILITY DUE
I HEREBY ACKNOWLEDGE TH :HAVE READ THIS APPLICATION THATTHEINFO MATION APPLIC ION A PROVAL
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GIVEN iS CORRECT. AND THAT AMTHE OWNER. ORTHE DULY UTHORIZED AGENT OF T!,.. P�111.11..
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WORKMENSCOPPEN I fZPANCE AND RCW 18,27 OFFI�l ATU�E
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SIGNATURE tOW�� (425)
771-0220 RELEASECrBY
7'rTENTIOM-- EXT 1333
IT IS UNLAWPIEILTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE - YELLOW - INSPECTOR
A FINAL INSPECTION
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK -OWNER - GOLD -ASSESSOR
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IF PRIVATE PROPERTY ONLY. ANY CONSTRUCTION OWNITHE PUBLIC
GRADINGIFILL
DOMAIN (CURDS. SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) LLREGUIRE
M SEPARATE PERMISSION.
qUIATeVURCHARGE
PERMIT APPLICATI N: 180 DAYS
PERMIT LIMIM I YEAR - PROVIDED W.BK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENG. REVIEW F Us
rLANDSCAPING
ENG. INSPECTION FEE
'A ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
;APPLICANT.
N INTE EST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY 01
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IN
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANYAND
A L LCLAIMSFORDAMAGESOFWHATEVER NATURE. ARISING DIRECTLYOR INDIRECTLY
INSPECTION FEE
RECEIPT
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT'S.ALL NOT BE
PLAIN CHECK DEPOSIT
E
DEEMED TO MODIFY. WAIVE OR REDUCE ANY R QUIREMENT OF ANY C TY ORDINANCE
PROVISION
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0 NOR LIMIT IN ANYWAY THE CITY'S ABILITY 0 ENFORCE ANY ORDINANCE
T TALAMOUNTDUE
IR ClIPT
1 HEREBY ACKNOWLEDGE T E IA.T.ISAPPLICATiON: THAT THE INFORMATION
HAT; AV
APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT AM THE OWNER. 09 THE DULY AUTHORIZED AGENT OF
T I PPI-11— 1. - I P-11 u -W -1 I'd by
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THIOWIER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
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CALL
'u" cIng Oftlelal 01 h, Depuly: Ild Flo III P I'd
TION ORIZED THEREBY. NO PERSON WILL BE
; AND IN DOING THE WORK AUTH
OF WASHINGTON RELATING To
FOR INSPECTION
1771-0220
'ecePI 1, ,k,Icdgn p.cI p—ld.d.
T
IN VIOLATION OF THE BOR C DE OF HE STATE
KMENS Co. RANC E AND RCW 18,27,
10
WoR PEN4f
OFFICIA ATU E
SIGNATURE (O:�_
(425)
-RELEASEcray 'DATE
ATTENT04—
EXT 1333
IT IS UNLAWkUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL FILE - YELLOW - INSPEC70R OT
- GOLD - ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK -OWNER
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