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THIS PERMIT AUTHORMS ONLY THE ORKNOTED.TRIS PERMIT COVERS WORK 70
BE DOBSON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON'SiE PUBLIC
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Recording Fee
DOMAIN (CURB$, SIDEWALKS, DRIVEWAYS, MARQUEES, UC-) WILL REQUIRE
SEPARATEPERMISWOM
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PERMITAPPLICAR N: 180DAYS
PERMIT LUMM 1 YEAH � PROVIDED WOR IS STARTED WITHIN IN DAYS
Engr. Inspection
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State Surcharge
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SEE BACK OF PINK PERMIT FOR MORE INFORMATION
lReceipt
'APPLICAW. ON BEHALF OF His OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
Traffic Mitigation
apGS
Plan Ohk Deposit
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IN [MEREST AGREES TO INDIMNIFY. 111END AND HOLD ARM111 '"' I'll 11
EDMONDS' WASHINGTON, IT OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY
Fire Reviefiw
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ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARIS NG DIRECTLY OR INDIRECTLY
IE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
FROM THE
Fire Inspection
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Total Amount Due
DEEMED To MODIFY, WAIVE 09 REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABIUTY TO ENFORCE ANY ORDINANCE PROVISION.-
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Receipt
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORREM. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
Thi-ppilwi- 1, , � p-11 �nffl IIQ.N by M.
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
THEREBY. NO PERSON WILL BE EMPLOYED
CALL
B.1Id1nq Otfid.t ., hm/hu DqWy� d F .. — P. d,
TION; AND IN DOING THE WORK AUTHORIZED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON REILATING TO
FOR INSPECTION
WORKMENG COMPENSATION INSURANCE AND RCW 18,27,
0 a E DATE
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771,0220
RELEASED BY
ATTENTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771m0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109
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