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PERMIT APPILICATION: 180 DAYS
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SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Fire Review Plan Chk. Deposit
'APPLICANT ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
Fire Inspection Receipt III
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CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
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DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPI40VAL
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-
lication Is not a permit until signed by the
CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION 0 CODE OF THE STATE OF WASHINGTON RELATING TO
tal or his/her Deputy: and Fees are paid, and
FOR INSPECTION rec plisacknowlodgedinApaceprovldfd.
WORKMEN' MPE ION INSURANCE AND RCW 18.27.
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
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CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
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PLAN CHECK NO: VESTEE DATE Plumbing Leo
Mechanical
THIS PERMff AUTHORIZES ONLY THE WORK NOTED. THIS PERMn COVERS WORK TO
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DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.1 WILL REQUIRE J
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11 IRS,,ASSIGN :1 AN 0 1 :Ofjdc' M Plan Chk. Deposit
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-APPLICANT. ON BEHALF OF "IS OR HE SPOUSE .........
IN INTEREST. AGREES TO INDEMNIP��1404 =6
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EDMONDS, WASHINGTON. ITS OFFIC . EMP EES, AND AGE TS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR OAMAGES�OF WHATEVER NATURE. ARISING DIRE TLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS �VERLIM ISSUANCE OF THIS PE MIT SHALL NOT 13E Landscapeinsp. Total Amt. Due
DEEMED TO MODIIFY.W"OR REDUCEANY REOUIREMENWT OF CITY ORDINANCE
NOR LIMIT IN ANY WAY THE crm ABiurry. TO ENFOPCE ANY ORDI ' E PROVISION.' 11A
Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; 7w r THE INFORMATION N APPROVAL
GIVEN IS CORRECT� AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATIO
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REG ILATING CONSTRUC- I ation Is not a permit until signed by the
CALL as are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSOlk WILL BE EMPLOYED ?6RIC'I or hIsftr Deputy-, and Fe
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IN VIOLATIO R CODE OF THE STATE OF WASHINC TON RELATING TO FOR INSPECTION reC Pile acknowledged InApace plovid9d.
WORKME MPEN ON INSURANCE AND RCW 18.27. IAL I _fj. TURE
ATE
SIG E (OMER OR ENT) DATE SIGNED (425)
771-0220 RE�EASEO BY
OftNTION EXT 1333
I 'Ts UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
T
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE - YELLOW- INSPECTOR
CATE OF OCdUPANCY HAS 13EEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR
GREEN - ACCOUNTING
04/02 PRESS H RD -yoU ARE MAKING 5 COPIES
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