20020625.pdfDATE RECEIVED
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CITY OF EDMONDS
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OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDMINAGE
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FIRE REVIEWED BY
DATE
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LOT AREA
DATE
0 REPAIR
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REMARKS
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REMARI<.
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
VALUATION $
Descrinflon I FTE
PLAN 1"ECK
VESTED, DATE
Plumbing
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THIS PERMIT AUTHORIZES ONLY THE W RKNOTED. TH16 PERMIT COVERS WORKTO
Mechanical
ic
RE DOME On PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
BOMAN (CURBS, SIDEWALKS, DRIVEWAYS, MAFIQUEES. ETC.t WILL REQUIRE
SEPARATEPERMISSION.
PERMIT APPUCATION.' Use DAYS
Engr. Review
PERMIT Luset I Y BAR - PROVIDED Won IS STARTED WITHIN in DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ART,
'APPLIC ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Traffic Mitigation
IN NTEREST. AGREES TO INDEMNIFY DEFEND AND HOLD HARMLESS THE CITY OF
EDMONGI, WAIIIINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Review
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR I DIRECTLY
Pa.. '.�'SSUA.CE OF PER Ise ANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVETHIRS
Fire Inspection
REOUCLANY REQUIREMENT OF NYCITYORDI"NCE
NOR LIMIT IN ANY WAY THE CHYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
.
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I HERE ACKNOWLEDGE THAT � HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECr. AND THAT AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNS � I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
CALL
IN VIOLATIC, OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTIll
WORKMEN'S COMPENSATION INSURA14CE AND RCW 18,27.
r HE ONE E DATE SIPNED
(425)
'N�T
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771-0220
ATTENT1 N ,7-
EXT 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 OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109
FAX
FEE
Recording Fee
City Surcharge
State Surcharge
Plan Chk Deposit
Rao SIDI #
- - — -_ 4D
Total AnToUnt Due AOQ
Receipt #
CATION APPROVAL
I.. Is unut signed by the
.'hI'jht'D-P"Tard -as ate paid, and
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PINK - OWNER COLD - ASSESSOR
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