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DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
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STATE SURCHARGE(/
BE MIT APPLICATI N: 180 DAYS
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PERMIT LIMIT. I YEAR "PROVO 0 WORK IS STARTED WITHIN 180 DAYS
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END REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
BACK OF '
ENO INSPECTION FEE
-APPLICANT. ON BEHALF OF HIS 0 HER SPOUSE, HEIRS, ASSIGNS AND 5UCCESOnS
ALF OF
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INTEREST AG S o IN EM Illy, DEFEND AND HOLD HARMLESS THE CHY 01
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IN NTERES'L AGREES TO IND
2 EDMONDS. WASHINGTON, ITS OFFICIALS. EMPLOYEES, AID AD AT$ FROM ANY AND
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ld ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIHECTLI OR INDIRECI LY
RECEIPT��
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I FROM THE ISSUANCE OF THIS BE MIT. ISSUANCE OF THIS PERMIT SHALL
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WAIVE OR REDUCE ANY REOUIREJAEN c ORDINANCE
DEEMED TO MODIFY. W .0 TQFANY Ty
PLAN CHECK DEPOSIT
NOR LIMIT HANYWAYTHE CITY'SABILITY TO ENFORCE ANYORDINANCE
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TOTAL AMOUNT DUE
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]HEREBY ACKNOWLEDGE THAT' HAVE READ THIS APPLICACON� I HAT tHFINFORMATION
APPLICATION
APPROVAL
GIVEN I S CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT 01
CONSTRUC-
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IHEOWNER IAGREE To Go -PLY WlI 11 CITY AND STATE LAWS REGULATING
THEREBY. NO PERSON IR BE FEMPLOYED
CALL
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TION, AND IN DOING THE WORK AUTHORIZED L
OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
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IN VIOLA71ON
WORKMEN S COMPENSATION INSURANCE AND NOW 18,27�
SIGNA DATE
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DATE SIGNED
(425)
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771-0220
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ATTENTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
2
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL FILE - YELLOW � WSPECfOR
CATE OF OCCUPANCY HAS BEEN GRANTED. LIBC SECTION 109
FAX
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GEOSCIENCES INC.
Post Office B'Z 2385
Kirkland, WA 98083
Telephone (425) 827-1084
DAILY FIELD REPORT
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DEVELOPMENT SERVICES CTFI.
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