20030540.pdfDATE RECEIVED
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USE PERMIT
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION JOB
ADDRESS Z71
a ER NAMEINAME OF BUSINESS e��l SUITE/APT#
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YES C1 NO 0
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OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE
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k: BE DONE ON PRIVATE PROPERTY ONLY ANY CONSTRUCTION ON THE PUBLIC
2 Grading
:3 DO&IIAIN (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: IGO DAYS Engr. Review
PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WTFHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection
'APPLICANT; ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNWY 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 Receipt #
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapeinsp. Total Amt. Due
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' ---
Recording Fee Receipt # r _01
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 APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application Is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged In space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW` 18.27.
JMOFFIIGNATURE DATE
8 UBE V E OR GENT) DATE SIGNED JfA*
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771-0220 _EL Y 7 DATE
ATTENTION Off 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- L
ORIGINAL- FILE YELLOW. INSPE OR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 A
04/02 PINK - OWNER GOLD - ASSESSOR
PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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OWNER NAMEft"E OF BUSINESS
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MAILING ADDRESS LID FEE S
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METER SIZE LINE S�7 NO. OF FIXTURES PRV REQUIRED
NAM 43
YES E3 NO 13 35
ADDRESS REMARK;3
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CITY
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NAME BLO
ENGINEERING REVIEWED BY DATE
ADDRESS
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VARIANCE OR CLI SHORELINEORADBN INSPECTION BOND
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PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE I IIE;,T, ALLOWED PROPOSED ALLOWED PROPOSED
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TH16 PEWIT AUTHORIZIES ONLY THE WORK NOTED THISPERAkir-f—FRAWORKTO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBUC Grading
DOMAIN (CURBS, SIDEWALK6, DRIVEWAYS, MAnQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION. Engr. Review
`j
0ERMITAPPUCA'ir1ON: 180 DAYS
116. PERMIT`UMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180DAYS
Engr. Inspection
SEE,�AMOF PINK PERMIT FOR MORE INFORMATION,
'APPLICANT, ON dEHALVOF'IM,OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
IN, INTEREST AGREES TO INDEMNIFY 'DEFEND AND,HOID 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 PERMfE ISSUANCE OF THIS PERMIT WALL NOT BE
ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapelnsp.,
Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE
NOR LIMIT IN ANY WAY THI'_ CfIY8 ABILITY TO ENFORCE ANY ORDINANCE
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAL
OWEN IS CORRE" AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CnY AND STATE LAWS REGULATING CONSTRUC-
This application Is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
�CALL
Building Official or his/her Deputy: and Foos are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknowledged In space provided.
WORKMENS COMPENSATION INSURANCE AND RCW 18.27.
OFFI IGNATURE DATE
CDR AGENT) DATE SIGNED
(42
[MR-IGURE
=E
7 0220
7"1
R L D Y DATE
A�NTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CEFITIFI-
ORIGINAL - FILE YELLOW-INSPE R
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER GOLD -ASSESSOR
04J02 PRESS HARD -YOU ARE MAKING 5 COPIES
GREEN - ACCOUNTING