20020133.pdfAM DATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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FEE I Description I FEE
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PLAN CHECK NO: VESTED DATE
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THIS PERMIT AUTHORIZES ONLY THE ORK NOTED. THIS PERMIT COVERS WORK TO
11 DONE IN P11 PROPERTY NLY. ANY CO.STR.CT... 0. 'HE PUSLIC
Grading
Recording Fee
IBOMLAIN (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
City Surcharge 5--
PC 1WIDAYS
BABAMIYAPPLICATION:
PERMIT Dun. 1 Y � PROVI 90 WORK IS STARTED WITHIN too DAYS
Engr. Inspection
State Surcharge
See BACK OF PINK PERMIT FOR MORE INFORMATION
*APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Traffic Mitigation
Plan Chk Deposit
IN INTEREST, AGREES To INDEMNIFY. DEFEND AND HOLD HARMLESS THE C17Y OF
Receipt III
EDMONDS, WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
ISSUANCE PERMIT SHALL NOT
Fire Review
FROM THE ISSUANCE OF THIS PERMTE OF THIS 85
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Fire Inspection
Total Amount Due
ol NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
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Receipt # 11,7m;zl
I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPRdvAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMP WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
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TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
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RELEASED By
ATTEVION
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
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