20020618.pdfDATE RFCEW�
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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Building Permit
City Surcharge
PLAN CHECK NO: IESTEO DATE
Plumbing
Mechanical �()
THIS PERMIT AUTHORIZES ONLY THE WO K NOTED. THIS PERMIT COVERS WORK To
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t: 11 DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION I" THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS MARQUEES, ETC�) WILL REQUIRE
SEPARATE PERMiSSION.
—
PE MITAPPUCATION: INDAYS
Engr. Review
PERMIT LIMIR. I YEAR - PROVIDED WORK IS STARTED WITHIN 190 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-APPLI W, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Re"aw
Fire Review
Fue
Plan Chk. Deposit
0
IN INTEAREST, AGREES TO INDEMNIFV, DEFEND AND HOLD HARMLESS THE CITY OF
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EDMONDS WASHINGTON ITS OFFICIALS, EMPLOYEES, AND AGENTS F OM ANY AND
Fire Inspection
Receipt #
ALL CLAJMil FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY 0 R INDIRECTLY
FROM THE ISSUA OF OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscape
Total Arnt. [)us
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY 0.0--
Receipt III
I HERE Y ACKNOWLEDGE THAT I RAVE READ THIS APPLICATION; THAT THE INFOR ON
I'S�T!?N
HT OF
GIVE IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED A HT or
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING C STRUC.
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TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE MPLOYED
INVO T 0 HE LABOR 00;�TTH E STATE OF WASHINGTON RE TO
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FOR INSPECTION ts�'
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..R�.�.�ATION INSU . AND RCW 18.27.
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ATTENTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL FILE YELLOW -INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109
PINK . OWNER GOLD - ASS SSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
GREEN - ACCOUNTING
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