20020661.pdf, I _�ATE —RECEIVED
PERMIT EXPIRES
CITY OF EDMONDS
PERMIT
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CONSTRUCTION PERMIT APPLICATION
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THIS PERMIT AUTHORIZES ONLY THE ORKNOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPER" ONLY. ANY CONSTRUCTION ON THE PUBLIC
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Grading
DOMAIN (CURDE'SIDEWALIK% DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATEPE MISSION.
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Engr. Review
PERMITAPPLICATI N: INDAYS
PERMIT LBUM. I YEAR. PROV` ED WORK IS STARTED WITHIN 1 90 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-ILIC ON BEHALF 01 HIS OR HER SPOUSE, HEIRS. AISIGNI All' ESORS
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Fire Review Plan Chk. Deposit
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMOND" WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS MOM ANY AND
Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT $HALL NOT BE
DEEMED TO MODIFY, -IVE OR REDUCE ANY REOUIREMENT OF ANY CITY ORDINANCE
Landscapemsp. Total Amt. Due T6
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.
Recording Fee Receir I #
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT
APPLICATION API�
AM THE OWNER. OR THE DULY A THORIZED AGENT OF
THE OWNER. I AGREE To COUP WITH CITY AND STATE LAWS REGULATING CONSTRUC-
appliafl.n 1-1. P—a—fil aignad b, On,
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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
WORKMENS C3lAa6jSATION INSURANCE AND RCW Ian,
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One 01flaW , hirthar Dep,ty: and Fea are paid, and
FOR INSPECTION aa0pHkr-I.dqadI.ap ... pldad,
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SIGN DATE SIGNED
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IT IS UNLAWFUL To USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
ORIGINAL FILE - YELLOW - INSPECTOR
PINK -OWNER GOLD -ASSESSOR
04102 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
CITY OF EDMONDS
WILDING DEPARTMENT
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
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Ceiling Insulation
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SPECIAL INSPECTION
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FINAL APPROVAL FOR
OCCUPANCY ..................