20030337.pdfDATE RECEIVED
[PERMIT EXPIRES )1/) qLjl,�L
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USE DERMIT /I
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CITY OF EDMONDS ZONE
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JOB StN/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS [Cl A,)
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OWNER NAMEINAME OF BUSINESS
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
�Q44 LID FEE S
MAILING ADDRESS jr ( J i tisur mpf
( J. PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW PGFIM R 'ad
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XfWI Street Use PieffEl't ,Gq'd
CITY EXISTING — PROPOSED Inspection Required [3
ZIP TELEPHONE Sidewalk Required 13
Urwlerl;round
REQUIRED DEDICATION— FT WMUFUqW� 11
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES13 NO 13 z
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ADDRESS REMARKS z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CITY ZIP TELEPHONE
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n ENGINEER EftWfXS1AV-U1I0N KhlQUIKbU DATE
ADDRESS 0 STREET TO BE CLEANED OF DEDPJS
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- SIDE SEWER MUST BE CAPPELVAJ&
ZIP TELEPHONE PROPERTY LINE
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COMPLIANCE OR
ADDITION COMMERCIAL CHANGE OF USE
PARKING LOT AREA PLANNING REVIEWED BY DATE
06
0 REMODEL MULTIFAMILY S113N REQ`D PROVIDED
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REPAIR GRADING [3 FENCE X
CYDS ( FT) REMARKS
DEMOLISH 0 TANK OTHER
0 GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT 0 ROCKERY FIRE ALARM
(TYPE OF USE. BUSINESS OR ACT -BY--
CHECKED
OJ�Mr OCCUPAN
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/'A. , GROUP
NUMBER NUMBER OF ITICAL SP
OF DWELLING AREASR ECIAL INSPECTION AREA OCCUPANT
Cj!g�L;Z I I LOAD
STORIE UNITS MR;: REQUIRED 0 YES
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/171NAL INSPECTION REO'D
LO 65 VALUATION
$
Description
FEE
Description
FEE
Plan Check
L4 0
State Surcharge
I
HEAT SOURCE
GLAZING %
LOT SLOPE %
Building Permit
VESTED DATE Plumbing
City Surcharge
PLAN CHECK NO,
V-1h 1 2 — Le =
Mechanical
THIS PERMIT AUTHORLZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
Engr. Review
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Fire Review
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIF� DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANYAND
Fire Inspection
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapeinsp.
DEEMED TO MODIP4 WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fe
I HERE13Y 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-
CALL
TION; AND IN RPkG THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATIO OR CODE OF THE STATE OF WASHINGTON RELATING TO
LAB
FOR INSPECTION
WOR W"ZQE
KME1 COM ATION INSURANCE AND RCW 18.27.
COM 1,
(425)
SIG AGE" I
DATE SI NED
771-0220
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
P, 00" Is no, a permit until signed by the
, hitith., Deputy: and Fees are paid, and
aCknowicidged"INsPaco provided.
ENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- nRi w� �tf - YEI I ON AAN
Ffj
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 ER - Got D - A"
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOI INTING
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DATE
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425-489-4040 P. 2
A-T
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S
A 'BESTO-TEIST,
INC.
ASR
STO, URVEY
1h S1.
8928196
SWI. _Edmonds 'A 98026
A:
Page I (Y'5
!,\`9230529
:4aJ- 26, 208. 1
8-115 o-4.1" St. Sw
Fthi-osids, NVA 98026
Aiw: (.'at-] 0upp
1'2h-. 206-714-9429 Fax: 425-778-143
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on Nlay 19. 21003, Asbesto-'I'est persoinel
conducted an Asbestos survey (per
I.J.S.E.P.AJA.H.E.R.A. guidelines as
-pec i l'ied by Puget Sound Clean Air
desianatcd and s
-1gencl- and Washington State) (?Lt�oq.je
78 lge St. SW Edm . . . . . . . . .
q2 onds, SnoheMLs_hCoq2ti�
Washinelon 98026 is Survey plirpo
se s to identil� any Asbestos containing Materials that
I
I y be present and wil I require prof6
Tia
sional removal prior to demolition.
N1111RATIVE
OFFINDINGS
BASIC CONSTRUCTION: '!'he
one story house is an a concrete and wood toundall on.
exterior sidinp, is wood. 'I'lic wood siding
vapor barricr was sampled. 1*he roofing o"ver the main
house is wood shake over composition.
[he composition roofing was sampled. 1'he torch down
rooling materials were also sampled f
-orn over the porch and attached carport areas.
INTERIOR CONSTRUCTION,
FINISHES, A ND FLOORINGS:'I'lie, interior is drywall
A
and wood. The drywall/taping materi
Is were unifo rmly sampled. Vinyl flooring, materials with
relating backing-, and mastics were sampled
per ca h located homogenous area. 'Hie. splash tile
'I'he
mastics and Formica mastics were sampled
fro ni the kitchen and bathroom areas. li-ht
textured paint was sampled from the
-n
Jtchen/dinette & bathroot ceilings.
ELECTRICAL SYSTEM: "I'lie el-,ctrical
wiring insulation is not ofthe kind to.he A(-'M and
0-
IV,
was not sampled. Anv suspect electrical
wiring insulalion or uttv .�jispevi IS] (11hermal 6�1,,sletn
Insulation) found in. aroun(4 ot behi
0 un v lociwfedja� e ot breaker boxes should be cot
YM
(Asbestos Containing M
to be A CAY gM
thoraloty analwis.
terial), i inless determined othenvise til, ic
0 ,
M
.
ATTIC /WALL I NSULATION:'Ficre
was no relating suspect ACM located.
PLUMBING SYSTEM:'I'licie was
no tclatiiig suspect ACM located.
RECEIVED
J
JUN 19 2003
DEVELOPMENT SERVICES CTIFL
CITY OF EDMONDS
1429 Ave. 1). P.1#18 t$187, Snohomish, WA 98290 ph: 206-914-"Il) fax; 360-563-2469 page. 206-540-2401
I
Ma�j 126 03 (14: 40p
42s-4B9-4040 p.7
PLEASE NOTE ADDRESS CHANGE FOR INVOICE AC CTS. PAYABLE
PLEASE PEM I I''I
BESTO-TFIST.) INC.
1429 Ave, D. #187
Snohomish, WA 98290
.(425) 489-4040
14
IN#230529
5120/03
CC Coustruction
8416 192nd St SW
t
Edmonds, WA 98026
Attri: Carl Clapp
Ph: 206-7`14-9429 Fax: 426 .778-1433
P.O. NIA
asbeblus survt!y
Regaiding:
8928 ig Gth St. SW, Edmonds, WA 98026
Location-
I asbesios survey
10 9Sberlos SaMPIOS M 125 ea
2 plos tree of Cnjige
arnounk paid
7A
$250.00
$260.00
($50.00)
$0.00
$450v00
iTOTAL AMOUNT DUE ON RECEIPT
R5C;E:jV5D
JU14
DEVELOVMENT SERVICES CTR.
CITY OF EDMONDS
.q
00 04:38p
A
pt
42b-489--4040
P. 6
16, 2003
Page 5 of 5
1AW 23 05 2 9 Asbesto-TeA Inc. (206) 914-5500
8928 r9e..St. S ff-,- Ednwnds. Snohomish County, Washin -glon 98026
Some sample anall�ses lk-led ina ' v be a t -epresentative analysis oJ*lndivt(lual and separate samplings an(i atudYsts q/
hoinitwennids materials. os prescribed ol.,.I.H.L.R.J. proim-01.
ros is detected, those samples containing asbistost
Samples taken are listed it their cori -esponding analyses, 1j'asbess
ore lisiedfirsf and noted it uh the ininals Af-11
Y: hiring demolition or renovation, antv additional hidden or covered suspect materials stintlar it) those j identified in
the survet, tire located /may include but riot limited to- sheet vinvilflooring, titieflooring. ivall or ceding texturings or
points, concrete siding ot skirting cement pipes, cement wallboard. electrical cloth, electriced wiring insulution.
thermal paper, wallboard, joint compounds, viptyl it -all coverings, spackling compounas, oi- anv whei suspect I` I
(Therrnal S.v.vtem Invulation,17, 1hrYshoidd be treated (is Asbestos cantaining islatet -iais unless detet mined to be non-
asbestos bY li iboratory upui4tstis
Note: Asbesto-1rest, Inc. does not guarantee approximations of quantities of ACNI, which may be listed with
o 2ined by
the analyses. It is therefore i ecoitimended professional abatement price and/or disposal quotes be bt
inquiring as to fees per area of specific AC1%1 material (i.e. square or linear foot, etc.)9 or by on site assessment.
4ny andaY niaterials idenfiftedas ACAI in Ilds report must be abatedprior toACM disturbancel renovation. or
dernolition. All matcTials Identified asA CAI must be prqfessiopzal�v abated kv a licelLv ed wbaros abatement
contra(yor prior to util, dAiurthance.
analytical tLia: nietho& USE-11A 61111-IR43/116" OILM); WAC 29"2-o775J Apl). J
k ACM signifies"As
PACM -sunrcd AshLstus sconiairtirigNiaierial
CAB sagnaiestt*t onercic Aslvstos Huard"
tillio
signities "'i'licrinui System hisulation'
IWAC sigiiifics "lleating Ventilating Air- Conditioning"
NAD sivilities "No Mbettilos ifticuielf"'
*90nv Iwaxiii is llic USIAIA regiflitory hillit I r asix. os in bulksarnples,
st
ain asitieslos, thus rleg tt%e PIA results Lannot be
PLM hai been kno%�m to miss usticsios in small percentages ol'some samples, %%hich contz a Ni
N, to insure ani - insinall
vvinisniced. Floor til4cs arld %%ipcs should bc tested with Stim or 11 lyticai aceuracy when reporteJ
p
Ashesto I est. Inc. claims respoitsibility tiarsairipie content only.
EN[) 0FR010RT
Arl,yiiik Huffinlond
Ana�vzicul Chemist, B.Sc.
AIHA
RECEIVED
JUN 19 2003
DEVELOPMENT SERVICES CTR.
CITY OF EDMONDS
a
ma-�j .26 03 04: 39p
425-409-4040
RECEIVED
DEVELOPMENT SERVICES CTR-
C11. EDMONDS
p. 5
I
M a-jo 26 0:1 04: 39p
-425-489-4040
Mqr "6. 2003
Asbesto-Tal. Inc. (206) 914-5500
IM230529
h Vt. in on 98026
�5 dLywnitv S ohon Un
$928 19W
ied as ACM or PACM in this report (and/or additional materials
Any and all materials identif Us I
9%sociated with the structure that may be discovered and later identified as ACM or PACM), III
be professionally abated prior to demolition. ASSESSMENT AND QUANTIFICATION OF ACIVI
FOR ABATEMENT PURPOSES AND/OR PRICING FOR REMOVAL SHOULD BE
DETERMINFI) BY ON SITE EVALUATION, AS J,ISTU) QUANTITWS ARE &N
I APPROXMATION ONLY.
IS,-IS8rS?'().V (UN7:4JN1M;4jAT 91-41.
N*MPIX
ly
ANALYSIS ID ASHESTOSLrrVI 1ANT1'I OTHER MATLMAL
chrysotile 2-5%
1.0) TORCH DOWN ROOFING y es
torch down roofing over 1m)rch area AUNI
Note: The asbestos is in the bottom inver of roofing felt material.
NONAFMABLF-APPROX. 120 SQ. Ff.
I
p. 4
non -fibrous materials,
A,
tar, cellulose, fiberglam
0
NOTE: Any colors or kinds of floor tile and/or mastit s backing that were not discovered in
contain asbestos
this survey and may later he located in fbisstructure are also presumed to
unless tested otherwitse by laboratory analysis
THERE WAS NO ASBESTOS DETECTED IN Aro� OF THE REMAINING SAMPLES TAKEN . . . . . .
non -fibrous materials 11'�..;:.��
2.0) drywall NAD
(,c!1ulosc, fiberp.lass,
Paint. (J."ypsuul)
ryw 11 taping compounds NAD non -fibrous materials,
2.1) d
cellulose, fiberglass
SAMPLED PER AKERA PROTOCUL
2.2) surface paint (homogenous
throughout) NAL paint, cellulo
INAD non -fibrous materials..
3.0) window glaAng
cellifloso
4.0) wood siding vapor barrier NAD cellulose, tar
-ior
material beneath wood siding extei
non -fibrous materials
5.0),-qheet vinyl flooring NAD
hathroom & Idtchen/back entry surface -color: cresin square
5. 1) mast ic NIA D
non -fibrous materials
6.0) %.-,heet %inyl llooring NAI)
cellulose
2"' layer-ldtchenj back entn'-col0": tall
6. 1 mastic N A D adlics
E E IVS: D
:C
jUA
EvELoPMENT SERVICES CTR-
DI
0TY0FF,0""-"0S
Mlu 26
03 04:38p 425-i89-4040 p.2
M(q 26, 200.3
Page 2 f-Y'5 -55(
Asbesto-Test, Itic. (206) 914 10
89281 9(;1, St. S Ff 'dmqndjt Lgy�iottdsh Cqullb��hi�ulld 98026
HEATING AND VENTILATIO N SYSTEM: 'I'liere is a wail furnace in the living rooni.
There isalso some baseboard/wall electric licat in the hoose.There was nos uspect AClvl visually
located associated with any of the heating units. Note: It was not possible to disinande the
healing units to locate antkor evaluale any additional susP eel ACM which mav be
roncealed, inside t he units, or associened it? hidden areas. it is out upinjon any.fin-1her
nated by the pro eel inanag andlor
handlini, ofthe heating anits should be coordi 'i
iihatementeoniraclor. If aRy additional relating suspect niaterials are locatedpriw -10
11101or during anj, dernolition or rcnOVation. at�y anjj till additional reiaied suspect
W,,
malerialsshould he considered lo be ACM (Asbestos Containing iVaterial), unless
defermined to be otherwise bt laborator), analysis. I'liere was no suspect ACM visuaBY
ssooiated with the tire
located a pluce Sys
Misc.: f he window giazing was sampled.
Additional Structures on site included in survey.: None. 'I lie car port is attached.
# o structures included in survey one house
.4!;
Requested by: Carl Clapp
I 7r
A
ArLynn I-larriniorid, B-Sc.
Inspector, cernfied A.H.F—R.A.
acered.#CLS327 (Expires 9/11/03)
+4
'RECEIVED
JUN 19 2MB
DEVELOPMENT SERVICES CTR.
CITY OF EDMONDS
PHPThER CON'S IC Fa-x ma'4 '28 '03 5:40 P. 01
PARTNERS CONSTR CTION.INC 1313souTHCENTRALAVF, SUIrEA
KENr, WASHINGTON 98032-7409
LICENSE ;N PARTIVC:1065NU ASBESTOS UCENSE # 1172 (.*oa) 675-7429 FAX (25a) 852-706
EMAIL PARMERSCIOAMLOBAL NET
ASSFS70S ASAT EMSNT ASSE-STOS MANAGEMENT GENERAL CONTRACTOR
PROPOi�,:.,� =3MITTED TO, DATE! May 28, 2003
SITE: 8928 igOP Street SW
CC CofnAructlon Edmonds, WA 98026
8415 192'4 Street SW
Edmonds, WA 98026
2 714-9429
06- Asbestos AbatuMQnt
Attn: Cori CIAPP
We heroby suWft sP6Cff1C-W10r'% WW ustinwitwa (ol:
Provide labor Rnd materials for removal and disposal Of Asbestos Containing Materials as follows:
5,
Exturior.,
Remoye approximately 120 SF ACM (non4riable) Roofing from Porch of Home.
to
Price Includes C 'ommerclal Demolition Perm it with PSCAA. $ 200-00
rn
-All woj* to be done by ce Alfied wo*ors strict IV following all local, state alid fed oral regulations. These
P �ices Include permits and require d air monitoring, but do not include sales tax.
r
O)Vo Aoo,4~ Itersby to furnish MQU!"W1 and labor-complato in accordance with above specitl a for ft sum of
621VAn—tAudir d d Wlam ($ 776.0g
payment to be made as follows: Balance Due In Full On Completion.
iod. All wo rk to be CoMpWW in a workmanlike
All material �j,qusrxntwd to be as specif AuUwfttd
manner -y-cording to stextord practic=. Any aftration or deviation from above OPEC signature:
1� LvmWft extm costs will be executed OWY uPw wrlmn orders, and Will become an
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axtra charge over and above Vie estimate. All agreements conftW upon strikes,
or delays beyond our Gontro 1. Owner to carry fire, tornado and oftir necessary NOTE: This prWssl maybe W Mwn bY
.4
socklortu
insurance. Our warkom are fully COvered by Workmen"s COMPOrIbAfti Insurance. us M occopted wM In days.
%ccopi"Cop Of %VP"/. Tho above prkmv, speciftcattons and coAditiOns
are saftfodory &-W or" hereby actspigd. You sire *uftrized to do " Work as sPac"W,
A late charge of 1.5% per rnonth will be
Payment will be made as oufftnod above.
charged on oil pAtt due accowils pkm collodion andlor oWntey's fee It It is
IWO" fimir sairwo". Signaturv:
RECEIVED
JUN 19 M
1A
MELoPMENT SERVIr". CTR.
CATY OF t"_-.;jNDS
FINAL P JECT APPROV FORM
TO:
DATE:
MEMO TO: PERmyr COORDINATOR, BUILDING DIVISION
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RE -INSPECTED OUTSTANDING ISSUES 'GRANT FINALPROJECT APPROVAL
Date -------- Si
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Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation
.......
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'ON
SPECIAL INSPECTI
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY .................. m
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EXPIRES
YRMIT
ass
CITY OF EDIVIONDS
UpEj. tR MT
ZONE -I'L--'PN
MBER
CONSTRUCTIONf
,2,1,Tj-- XPPLICATION
y
JOB SIJtV/AP`T#
ADDRESS Lq t � ( Cl W, a�j
NAMEJfNME OF BUqWESS
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
EOWNER
JLI 0 1
M MA
5 AILING AADDRESS
1 J.
lfwff
L FEE $
JD_
ITESCP AP
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP f4w Penrit
Straei Use Serm teq'd
CITY ZIP lLEPHONE
EXISTING — PROPOSED inspection Required
Sidewalk Required
FT Underground
REQUIRED DEDICATION
Wiring required
NAME
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES 13 NO 13
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ADDRESS'
REMARKS 49r
OWNERICONTRACTOR RESP SIBLE FOR EROSION Cb?OTROUDRAINAGE
CITY
0 rl C-7penif CBL.#
—A
DATE
EERj_1 F Eff
WPECTION
ADDRESS 7 j
REQUIRED
0191f
C ZIP TELEPHONE
ED BY
LU
ER MUSt BE CAPPED AT
SHORELINEORADB# INSPECTION
VARIAN(;� ORPLO BOND
LICICYBER EXPIRATION DATE POSTED
A
Alelle- ETER B [N'F*A,03t
C( C 6Q 111
=
AMN MEAP HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. ID/ 1 Z40 -6
d
co EMP AL�OWED 2PROPOSED ALLOWED PROPOSED
15UM�'W AP ED DUM SITS bILY
76 04Q 12 410, $
I -
P. I
LOT COVEbFX- U r"OSED SETBACKS (FT.)
NEW PLUMBING// MIECH ACLOWE 4WCk9W I(WCAWIDE REAR
COMPLIANCE OR
ADDITION COMMERCIAL CHANGE OF USE
FOR IN4PLICTION REQUIRE41ENTS
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or,
REMODEL MUCTIFAMI �S I IG ; Nv
PARKING LOT AREk G REVIEWED BY DATE
RECYD I PROVI DED
CL
0 FE�
REPAIR,, GRADING �E
CYDS FT)
X
REMARKS
OTHER
DEMOLISH TANK
GARAGE �[3 RE7AINING WALL F RE SPRINKLER .
CARPORT ROCKERY FIRE ALARM
C,
small
OWE OF USE, BUSINESS OR AMWJV�,
N
CHECKED 13Y OOCUPANT
TYPE 0 C "ST Ar e
GfINP
N NUM ER OF CRITICAL
F, D
0 UMBq' WEBLLING AREAS qg
OCCUPANT
- AREA LOAD
-STORIES' UNITS NUMBER
REQUIRED YES
DESCRIBE WORK TO BE DONE
r
REMARft " 'e.
PROGRESS INSOICUM ONREaD
%F"VC VW)ffj1WKECTI
9
X
cloq
C!!:ft
VLOMON
$
0 *K
WdZiption
scrIP001C.
, �E
heck t�g�urcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit City Surch
PLAN CHECK NO. VESTED 5�TE
Plumbinj Ira
7
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMi3, IiOVERS W6RK TO
sb
echanicall
t: BE DONE ON PRIVATE PROPERTY OHLX ANY CONSTRUC11QU ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEE$, EY10.) WILL REQUIRE
SEPARATE PERMISSION. r�.
ngr. Review
PERurrApPuCAT16) lle�DA'V*', IN ISO DAYS �ngr.
STARTED
PERMIT LIMM I YEAR - PROVIDED WORK IS
Inspection
to
SEE BACK OF PINK PERMIT FOR MORE INFORMATIO
...
'APPiLICANT, ON 13ERALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
'FIre Review, Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM 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 SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscape Insp. Total Amt. Due
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
Recording Fee Receipt # Z L-r I
I HERE13Y ACKNOWLED43E 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 OWNER4. I 10 COMPLY V61TH CITY AND STATE LAWS REGULATING CONSTRUC-
This rmit until signed by the
,,;�Jllon' Is not a pe
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TION; AND �IN 6 WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
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IN VIOLATIO JABOR CODE OF JHE STATE OF WASHINGTON RELATING TO
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FOR INSPECTION 1ptl acknowlodgedIrypece provided.
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IT IS tiRaWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL41 YELLOW- NS E
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