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[PERMIT EXPIRES
PERMIT
CITY OF EDMONDS ZONE NUMBER 0,V
CONSTRUCTION PERMIT APPLICATION JOB SUITEIAPT#
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PLAN CHM VESTED DATE
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THIS PERMIT AUTHORMS ONLY TWE Won NOT D. THIS PERMIT COVERS WORK To
81 BONI ON PRIVATE PROPERTY ONLY ANY CONSTRUCTION ON THE PuGuc
Grading
Recording Fee
OAUUN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
City Surcharge
PC MITAPPLUZATION: 100.13,
PERMIT UMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT MR MORE INFORMATION
Engr. inspection
State Surcharge
'APPLIC ON BEHALF 01 HIS OR 11111 1POU11* HEIIII, ASSIGNS AND IUCCEROS.
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Plan Chit Deposit
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IN INTEREST AGREES TO INDEMNIFI. DEFEND AND HOLD HARMLESS THE CITY OF
I FlICALS. EMPLOYEES, AND AGENTS FROM ANY AND
EDMONDS' WASHINGTON, IT 0
Fire Review r
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ALL CLAIMS FOR DAMAGES 0, WHATEVER NATURE ARISING DIRECTLY OR INDIRECTLY
FROM THEISSUANCE OF THIS PERMIT. ISSUANCil OF THIS P ERMIT SHALL NOT E
Fire Inspection
Total Amount Due
1 �45
DEEMED TO MOD[". WAII E OR REDUCE ANY REQUIREMENT 0 ANY CITY ORDINANOCE
NOR LIMIT IN ANY WAY THE CtTVS ABIL rY TO ENFORCE ANY ORDINANCE PROVISION.-
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I Receipt #
I HEREBY ACKNOWLEDGE THAT � RAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPRO�VAL
GIVE IS CORRECT. AND THAT AM THE OWNER, OR THE OULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
This areal cation Is not a permit until signed by the
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
Building Offlc�al or his/her Deputy: and Fees am paid, and
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WORKMENS COMPENSATION INSURANCE AND DOW 18.27.
OFF DATE
SIGNATURE low hal �757
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771-0220
RE�"Eo BY
ATTENTION
EXT 1333
IT IS UNLAWFUL To USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTtFI-
ORIGINAL - si Yi 'W
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
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