20020033.pdfDATE RECEIVE:,�
PERMIT EXPIRES
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CITY OF EDMONDS IZ� I'E R �X 6
CONSTRUCTION PERMIT APPLICATION JOB SU,TCIAPTk
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'l
VALUATION
FEE
PLAN CHECKFEE
--- GLAZING LOT SLOPE I
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BUILDING
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STED DATE PLUMBING
MECHANICAL
THIS PERMIT AUTHO IZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK To
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THEP B
DOMAIN (CURBS, SIDEWALKS, DRIVE S, MARQUEES, ETC.) WILL RE QUUIRI B
WAYMISSION.
SEPARATE PER
GRADINGIFILL
5u/51 —
PERMIT APP.CAA N: 180 DAYS
STATE SURCHARGE
14
PERMIT LlMlT�. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEC BACK OF PINK PERMIT FOR MORE INFORMATION
ENG� REVIEW FEES
-APPLICANT ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS ANOSUCCFSORS
ENO INSPECTION FEE
AEC
IN NT8REST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
2 E MORES, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND INSPECTION FEE
� A L CLAIMS FOR DAMAGESOF WHATEVER NATURE, ARISING OPEC TLYORINDIRECTLY
,
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
1�17 17
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1
DEEMED TO MODIFY, WAIV OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITY'S ABIL ITY TO ENFOnCE ANY 0"' -
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TOTAL AMOUNT DUE
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1 HEREBY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION. THAT THE INFORMATION
APPLI ATION APPROVAL
GIVEN IS CORRECT AND THAT AM THE OWNER, OR THE DULY Au rHOPIZED AGENT OF
:
THEOW14ER I AGREE TOCOVPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
TION AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN vibLATIONOF THE LABOR ODEOFTHESTATEOrWASHINGTON RELATNGTO
FOR INSPECTION
A AF..
WORKMEN'S COMPENSATION NSURANCE AND PCW 18.27
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(425)
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SIGNATURE A
DAT27ED
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771-0220
ATTENTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
1
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE - YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. DEC SECTION 109
FAX
PINK -OWNER - GOLD -ASSESSOR
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