20060227.pdfDATE RECEIVED
PERMIT EXPIRES
CITY OF EDMONDS
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NUMBER'
CONSTRUCTION PERMIT APPLICATION
JOB SUITE'APT.
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THIS PERMIT AUTHORV S ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
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SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engn Inspection Plan Chk. Deposit
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSCR$
Receipt #
IN INTEREST. AGREES T INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY 01
V EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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ALL CLAIMS FOR DAMAGE WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
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FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE 08 REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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APPLICATION APPROVAL
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
AUTHORIZED AGENT OF
CALL TI,.� V
GIVEN IS CORRECT: NO THAT I AM THE OWNER, OR THE DULY
WNE . I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
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INSPECTION
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
FOR VP� �-1-10,10111,Ked �� SPUI P111-d'd
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN S COMPENSATJ=NCE AND RCW 18;27.
(425) O11ICWj1A11RE DATE
DATE SIGNED
771-0220
RELEASEL�`ey IATEI
EXT. 1333
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI.
ORIGINAL FILE - YELLOW -INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. USC109 / IBC1101 IRC110.
PINK -OWNER GOLD - ASSESSOR
6/05 PRESS HARD - YOU ARE MAKING 4 COPIES
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMOTO: PERMIT O0�D,,Af)R,_BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
ENGINEERING DIVISION DATE
PLANNING DIVISION DATE
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Date Signature
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Permit Inspection Details
Permit: BLD20060227
PERM IT TP,'IX
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