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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERdIY COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
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Engr. Review
15 PERMIT APPUCATION: 1160DAYS
PERMIT LIMIr I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire R view
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMrr. ISSUANCE OF THIS PERMIT SHALL NOT BE
91 DEEMED TO MODIFY, WAIVE OR REDUCE
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ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORD114ANCE PROVISION. -
Record ng Fee
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
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-
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TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
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GV31_�IF.(OWNER O�AGJEf"M DATE SIGNED
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
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CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
04/02 PRESS HARD -YOU ARE
Plan Chk. Deposit
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BE I ONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBUC
DOA AIN (CURSS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPUCATIOW ISODAYS
PE IMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAY8
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPIU ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTE IEST, AGREES TO INDEMNIFY; DEFEND AND HOLD HARMLESS THE CITY OF
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EDMON S. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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ALL C If FOR DAMAGES OF WHATEVER MATURE, ARISING DIRECTLY OR INDIRECTLY
FROM E ISSUANCE OF THIS PERMrr. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEME TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LI IT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINA14CE PROVISION.'
I HEREBY A ;KNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS I ORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THE OWNE 1. 1 AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
TION; AND N DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATI)N OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN$ COMPENSATI=&SURANCE AND RCW `18.27.
A DATE SIGNED
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street Use Perfrift Reqd
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METER SIZE LINE SIZE NO. OF FIXTURES
PRV REQUIRED
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REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG-D
VALUATION
$
UUME1,616LI
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
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Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
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Total Amt. Due
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IT IS UN FUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
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CATE OF 3CCUPANCY HAS BEEN GRANTED. UBC SECTION 109
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
'ATION APPROVAL
ri Is root a permft until signed try the
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