820133.pdfUSE PERMIT
CITY OF EDMONDS
ZONE NUMBER 82U 133
CONSTRUCTION PERMIT APPLICATION
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EXISTING RLOUIREDDEUICATION
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RIGHT OF WAY CONSTRUCTION PERMII REQUIRED
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STREET USE PERMIT REQUIRLD
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CITY TELEPHONE NUMBE
STATE LICENSE NUMBER CITY LICENSE NUME
Legal Description of Property - Include all easements
(show below or attach four copies)
SIGN AREA LNV. REVIEW AUtl rvU
ALLOWED PROPOSED COMPLETE EXEMPT 2 obi
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;ENCE K —_FTlDEMOLISH
INSP.I
SWIM
COMPLIANCE INSP.POOL
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DUMBER OF STORIES
NUMBEROF
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This Permit covers work to be done on private property ONLY. GRADINGIFILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns and
m successors In interest, agrees to indemnify, defend and hold
W harmless the City of Edmonds, Washington, Its officials,
m employees, and agents from any and all claims for damages of
a 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
°x nor limit in any way the City's ability to enforce any ordinance TOTAL AMOUNT DUE
provision."
I hereby acknowledge that I have read this application; that the
Information given is correct; and that I am the owner, or the duly ATTENTION
authorized agent of the owner. I agree to comply with city and THIS PERMIT
slate laws regulating construction; and In doing the work authoriz. AUTHORIZES
ed thereby, no person will be employed In violation of the Labor ONLY THE
Code of the State of Washington relating to Workmen's Compensa- WORK NOTED
II n Insurance. INSPECTION
ONAj''RE IOW NEN OR AG(rIT i D'T CijJED �l ` DEPARTMENT
7+ CITY OF
THIS SITE IS LOCATED IN THE CITY EDMONDS
OF EDMONDS. LOCAL SALES TAX 77&2525
ATTENTION SHOULD BE CODED 31.04.
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3,
10218
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APPLICATION APPROVAL
This application Is not a permit until
signed by the Building 011icial or his
Deputy; and fees are paid, and receipt is
acknowledged in space provided.
�F7A(,'S.SIGNATURE
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ORIGINAL — File YELLOW — Inspector
PINK — Owner GOLD — Assessor
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RECORD
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