20020218.pdfP�N DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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REMARKS
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PROGRESS INSPECTIONS PER UBC 1101111FINAL INSPECTIC
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THIS PERMIT AUTHORINS ONLY THE WORK NOTED. THISPERMITCOVER WORKTO
CONSTRUCTION ON THE PUBLIC
6 DONE ON PRIVATE PROPERTY ONLY. ANY
a E WILL REQUIRE
:3 DO&MM (CURBS. SIDEWALKS. DRIVEWAYS MARQU E"UC
Grading
Recording Fee
SEPARATE PERM;
Engr. Review
City Surcharge -5-
PE MITAPPLICATION: ISODAYS
PERMIT LIMOR I YEAR - PRICING D WORK IS STARTED WITHIN 11PIDAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
State Surcharge 12
'APPUC NW1 O11N BEHALF F His OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESONS
Traffic Mitigation
Plan Chk Deposit
IN INTEREST. AGREES TO INDEMNIFY. DEFENU AND HOLD HARMLESS THE CITY OF
EDMONDS WASHINGTON. IT$ OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Review
Receipt #
ALL CLAIMiI FOR DAMAGES OF WHATEVER NATURE, AMSING DIRECTLY OR INDIRECTLY
OF THIS PERMIT $HALL NOT BE
FROM THE ISSUA CE OF THIS PERMIT ISSUANCE
DEEMED TO MODIFY; WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Fire Inspection
Total Amount Due
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
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Receipt #
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
I
APPLICATION APPI110VAL
GIVEN IS CORRECT. AND THAT AM THE OWNER, OR T14E DULY AUTHORIZED AGENT OF
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
ration Is not a ponrit until signed by ree
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
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ding Otfic�ai or his/her Deputy: and Foes are paid, and
FOR INSPECTION ..Ipli..ckn..I.d,.di..p..p,.Id�.
WORKMENS COYEE
,NSATION INSURANCE AND RCW 1827�
OFF ALS SIGNATURE DATE
[�';TURE (0 A.� DATE SIGNED
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771 -0220
ATTENTION
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IT IS UNLAWFUL To USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221 ':�k
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE - YELLOW -'INSPECIOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK, OWNER - GOLD� ASSESSOR
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