20020864.pdfDATE RECEIII D
PERMITEXPIRES
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PERMIT
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PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REO'D
1�11 'I'll 131-11117 19 30 020
APMSURE U1:60LIVIURVALvE, iPRV)
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Description
FEE
Description
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Building Permit
City Surcharge
PLAN CHECK N VESTED DATE
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THIS PERMIT AUTHORIZE$ Y - WORK —0. M
THIS PERO a COVERS WORK TO
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ON F.W.T. B.".
10FN)`FX'1 . ANY CONSTRUCTI ON THE
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=I DOMAIN (CUABS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC�) WILL REQUIRE
Grading
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2
PE MITAPPLICATION, INDAYS
Engr. Review
PERMIT LflUr� 1 YEAR -PROVIDED WORK IS STARTED WITHIN 180DAYS
SEE SACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
*APPLICAN7. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORs
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IN INTEREST AGREES TO �NDEMN Fy EFEND AND HOLD HARMLESS THE CITY OF
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CLAIM MAIN S AGENTS MOM ANY AND
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Receipt
IIL NATURE, ARIS NG DIRECTLY 01 INDIRECTLY
FROM THE I SUANCE OF IS PERMIT I
9 DEEMED TO SMODIFY. WAII SSUANCE OF THIS PERMIT SHALL NOT
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Total Amt. Due
Recording Fee
Receipt #
IHME8Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT I AM
THE OWNER, 08 THE DULY AUTHORIZED AGENT OF
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
APPLICATION APPR_0VAL
TION. AND IN DOING THE WORK AUTHORIZED THERIESY, NO PERSON WILL BE EMPLOYED
CALL
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IN VIOLATIO CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
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IIGNATUIrNI DATE SIGNED
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JIAIS S)GJATURE DATE
771-0220
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REL EAtED
ATTENTION
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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 INSPICTIA
04/02 PINK - OWNE GOLD -ASSESSOR
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SPECIAL INSPECTION
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FINAL APPROVAL FOR
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OCCUPANCY ..................