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THIS PERMrr AUTHORIMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLI C
Grading
2 0 OMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATEPERMISSION.
Engr. Review
PER MITAPPLICATI N: INDAYS
FE.M.M.11 ,,Aa. PROVID 0 WORK IS STARTED WITHIN 100DAYS
Engr. Inspection
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SEE 13ACK OF PINK PERMIT FOR MORE INFORMATION
-APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESons
Fire Review
Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON, ITS 0 FICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS PON DA.AGE. OF WHATEVER, NATURE ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT:. SSUANCi OF THIS PERMIT SHALL NOT BE
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Total Amt. Due
DEEMED TO MODIFY!, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CRYS ABILITY TO ENFORCE ANY ORDINA
Recording Fee
Receipt N
I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
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ION; 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
8,11ding Offid,I 0,�hlsjherDoputy: and F,,s 110 PlId. dnd
FOR INSPECTION dIpHdkn..I.d9.d I-P.. PIddd.
WORKMEN'S COMPENSATION INSURAN E AND Now 18,27�
DATE
LIT SIGNED
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I'DATE
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771-0220
*LEAM, DATY
ATTENTION I I
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 - INSPECTO
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE
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