20030669.pdfDATE RECEIVED
PERMIT EXPIRES
CITY OF EDMONDS
USE PERMIT
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NUMBERV&3--No
CONSTRUCTION PERMIT APPLICATION
JOB SUITE/APT#
ADDRESS
OWNER EINAME OF BUSINESS
74'r017;!;_e_ "11000
PLAT NAMEISUBDIVISION NO. LOT NO.
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Street Use Permit R6(fd
Inspecdon Required
Sidewalk Required
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NO. OF FIXTU�7
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REMARKS
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REMARKS
PROGRESS INSPECTIONS PER UBC I 08/FINAL INSPECTION REO'D
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VALUATION
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FEE
Description
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Plumbing
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THIS PERMIT AUTHORIZES ONVV THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY OHLX ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 160 DAYS
PERMIT UMIr 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 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 #
11 CLAIMS FOR DAMAGES IF WHATEVER NATURE, ARIS111 1IREC1 OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE 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
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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
APPEICATION
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
This application Is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
Building Official or his/her Deputy: and Foos are paid. and
IN VIOLATION OF THE LAB R CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknowledged In space Ided.
WORKMEN'S COMPEN RANCE AND RCW 16,27.
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RE(O R O� Af �E/
DATEXIGNED
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771-0220
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE - YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK - OWNER - GOLD - ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
FINAL PROJECT APPROVAL FORM
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RE-INSpECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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