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ft BE DONE ON PRIVATE PROPERTY ONLIt ANY OONSTRUCTION ON THE PUBLIC
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DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REG IRE
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15 PERMIT APPILICATION: 180DAYS
116 PERMIT IIJIMM I YEAR - PROVIDED WORK IS STAKED WITHIN 1W 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 #
-.1 R DA ES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
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EEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
OR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Recording Receipt # QZ 75 0-
I HERESY ACKNOWLEDGE 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 OWNER. I AGREE M 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 Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
OR INSPECTION receipt Is acknowledged In space provided.
WORKMEN'S COMPEN CE AND RCW 18.27.
F LS SIGNATURE DATE
si RE (OWNER (IR tGENT) DATE SIGNED
(425)
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771-0220
RELEASE DATIf
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EXT 1333
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t: BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
Do"N (CURBS, SIDEWALKS. DFInfEWAVS, IIIIARQUEES, ETC.) WILL REQUIRE Grading
fjRMISSION r;ngr. Review
PERUr1r�PP,UC6TIO1* lsacws
PERMIT LIMM I YEAR - PROVIDED WORK 15 64FITED WITHL 180 DAYi Engr. Inspection
SEE BACK OF PINK PERMIrf0R.MQR9 INFORMATION
'S AND SUCCESORS Fire Review PlanChk. Depolsit
"APPUCANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGN
IN INTEREST, AGREES TO INDEMNIFY DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLafEES. AND AGENTS FROM ANY AND Fire Inspection Receipt 0
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. Rue
NOR LIMIT IN ANY WAY THE Cff" ABILITY TO ENFORCE ANY ORDINANCE PRO`VISION.* Recordin Receipt #
I KERE13Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN 18 CORRECT! AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF APP JCATIO4 A�_PROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATINQ_CONSTRUC- This applicaIlon Is not a permit Wif 4WI�d by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or hWher Deputy: and Res are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO OR INSPECTION eecialpt is acknowedged in space provided.
WORKMERS COMPENIOWKMVWWRANC . E AND RCW 10.27. N;ATURE DATE
DATE SIGNED (42
8
- 771-0220 RELEASED Y DAT9
Lj
TTENTION TIL Off 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUC I URE
�'A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CER Fl- ORIGINAL - FI�t YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC StCTION 109 PINK ��R GoLD-ASSESSOR
04/02 R ES GREEN -ACCOUNTING
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