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IPERMIT EXPIRES
CITY OF EDMONDS
PERMIT
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CONSTRUCTION PERMIT APPLICATION
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THIS PERMETAUTHORIZES ONLY THEWORKNOTEC. THIS PERMIT COVERS WORK TO
Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION,
Grading
PERMIT APPLICATION: SEE ECDC 19.0040SEA)(5)
T PERMIT LIMIT. SEE ECDC 19.00�005(AXQ
Engr. Review Recording Fee
SEE SACK OF PINK PERMIT FOR MORE INFORMATION
Engr. inspection Plan Chk. Deposit
ON BEHALF F HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
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Receipt N
;APPLICANT,
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMOND WASHINGTON, ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
Fire Review
D ECTLY
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR IN IS
Fire InSpection Total Arnt. Duo
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FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY RE1111"IMENT 01 ANY CITY OEGINANC�
NOR LIMIT IN ANY WAY THE CETY'$ ABILITY TO ENFORCE ANY ORDINANCE PPOVISION�
Receipt #
lllc.p�,FSP 1 ?IP09,04 1
APPLICATION APPROVAL
IHERE Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
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THE OWNER, OR THE DULY AUTHORIZED AGENT OF
CALL ThSIPPI-110PISIOI.Pal ICanXXI9aAClX1XTd
GIVEN IS CORRECT. AND THAT I AM
THE OWNEM I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CON
8,11d, goth-j"Inalae, epon, and Feea ne pa,d, and
INSPECTION
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL se EMPILT(Ruc).
FOR
f-\' I, XNdq.d 1. IPIC, PlIrldld
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMBPENSApqfil%&�CE AND RCW 18:27,
OF ICIA RE DATE
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RELEASE Y JONTE
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EXT. 1333
T NsTION
IT IS UNLAWFUL To USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
SPECTION HA S BEEN MADE AND APPROVAL OR A CERTI
A FINAL IN,
ORIGINAL FILE - YELLOW - INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 I IRC110.
PINK -OWNER - GOLD - ASSESSOR
PRESS HARD - YOU
ARE MAKING 4 COPIES
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