20010845.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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MECHANICAL
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IT 0 N W R K TO
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
N 0 H P U L I C
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON TLE PUBLIC
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T W I L L R E I E
DOMAIN (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WIL REQUIRE
SEPARATE PERMISSION.
SURCHARGE
PERMIT APPLICATION: ISO DAYS
IT I ' A
PERMITLIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN IBODAYS
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ENG, REVIEW FEES
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SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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ENG, INSPECTION FEE
END
S G-S AND SUCC ES-FS
ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
;APPLICANT
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N INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
AND
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LAND'
�-ENTS F.. ANYAN.
I EDMON'SjWA,1�1'�N.110" IoTFSWFlIClAlS, EMPLOYEES, AND AGENTS FROM ANY
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-INSPECTION FEE
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PATEVER
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FROM THE ISSUANCE OF THIS ERMIT SSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
PLAN
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�FAN'-'Ty ORDINANCE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE -
)RO'NANCE PROVISION
NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.
TOTA,
TOTAL AMOUNT DUE
REC I
THAT THE INFORMATION
I HEREBY ACKNOW EDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFORMATION
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[CAT ION APPROVAL
EN
AUTHORIZED A .. T 0 F
GIVEN IS CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AD T OF
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7 EOWNER I AGREE TO COMPLY WIT. CITY AND STATE LAWS REGULATING
BE EM ILOYED
CALL
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TION AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON
IN V16LATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION -.10g.d pl-d..
WORKMEN S COMPENSATION INSURANCE ANDRCW 18.27
OF ICtALS SIGNAT D IE
SIGNATVRE� DAj�)GNE.C�j
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'BY
90RIGiNAL-FILE. IINSPEOR
771-0220
SED TE
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MEN
EXT 1333
Q-F U L 0 USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL I E TION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
I 'E
YELLOW -
CAT , C UBC SECTION 109
E OF OC FANCY HAS BEEN GRANTED.
FAX
PINK -OWNER - GOLD - ASSESSOR
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