20020322.pdf - LEGACYAAgAFPERMITEXPIRES
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CITY OF EDMONDS
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NEURNIB'ER:�W.,� -e)` A
CONSTRUCTION PERMIT APPLICATION
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ADDRESS
REMARKS
OWNERICONMACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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NAM
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CITY
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FIRE REVIEWED BY DATE
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DESCRIBE WORK TO BE DONE
REMARKS
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PROGRESS INSPECTIONS PER USC 108/FINAL INSPECTION REDD
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Description I
FEE
Description
FEE
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HEAT SOURCE GWING LOT SLOPE %
RED DATE
Plumbing
Mechanical
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVER WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ART CONSTRUCTION ON THE PUDILM
X
Grading
Recording Fe
DOMAIN (CURBS. SIDEWALKS, 11RIVEYANYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
City Surcharge
PERMITAPPUrATI N: ISODAVS
PERMITUMMIYEAR-PROVIDEDW SKIS STARTED WITHIN 180DAYS
EngE Inspection
State Surcharge
SEE BACK OF PINK PERMIT MR MORE INFORMATION
-APPLIC . 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 CITY OF
EDMONDS, WASHINGTON* ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Fire Review
Receipt is
FROM THE ISSUANCE OF 8 PERMIT. ISSUANCE OF THIS ERMIT SHALL NOT E
P
BE
Fire Inspection
Total Amount Due
DEEMED TO MODIFY; WAIVE Try
A REDUCE ANY REQUIREMENT OF ANY C ORDINAN
N OR LIMIT IN ANY WAY THE CITYS ASIUTY TO ENFORCE ANY ORDINANCE PROVISION.-
Landscapainsp.
Receipt #
I HERESY ACKNOWLE GE THAT I HAVE REM THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNE . I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATI G CONSTRUC-
CALL
" I signed
by Me
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILILNBE EMPLOYED
,,, VIOLATION OF THE LABOR Coos OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
8"" -.1. Dap,iy: and Fees — p.1d, end
WORKMENS COMPENSATION URANCE AND RCW 18,27.
OFR SIGNAT E
0 T
SIG (OW4NE11AGENTi E SIGNED
3
(425)
. _ �Z�jo//--_3- 0-1-
771-0220
Den
ATTENTION
W 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 ONCCUPANCY HAS BEEN GRANTED, UBC SECTION 109
FAX
ORIjINAL � FILE YELLOW � INSPECT&
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