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- CITY OF EDMONDS
USE PERMIT
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CONSTRUCTION PERMIT APPLICATION
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PROGRESS UBC 305 p
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(TYPE OF USE, BUSINESS OR_ACT TY) EXPLAIN:
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7INSPECTIONS
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NUMBER OF STORIES NUMBER OF (/!�•�L,�"�L
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NATURE OF WOR TO DE D NE (ATTACH PLOT/PLAN)
/V FINAL INSPECTION REQUIRED
VALUATION FEE
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BUILDING -7 J
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Plan Check No. I J MECHANICAL Z
This Permit covers work to be done on private property ONLY. GRADINGIFILL J%!
Any construction on the public domain (curbs, sidewalks,
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driveways, marquees, etc.) will require separate permission. STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: 1 Year- Provided Work is Started Within 180 Days
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"Applicant, on behalf of his or her spouse, heirs, assigns and fin! K' I
successors in interest, agrees to indemnify, defend and hold
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w harmless the City of Edmonds. Washington, its officials,
agents from any and all claims for damages of !�
employees, and
i whatever nature, arising directly or indirectly from the issuance PLAN CHECK DEPOSIT
of this permit. Issuance of this permit shall not be deemed to
modify, waive or reduce any requirement of any city ordinance
o nor limit in any we the City's ability to� nforce any ordinance TOTAL AMOUNT DUE
provision." j
I hereby acknowledge that I have read this application; that the ATTENTION APPLICATION APPROVAL
information given is correct; and that I am the owner, or the duly ,
authorized agent of the owner. I agree to comply with city and THIS PERMIT This application is not a permit until
state laws regulating construction; and in doing the work authoriz- AUTHORIZES signed by the Building Official or his
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ed thereby, no person will be employed in violation of the Labor ONLY WORK NOTED Deputy; and fees are paid, and receipt is
Code of he State of Washin on relat g to Workmen's.mp nsa- acknowledged in space provid d.
lion Ins ranCQ. INSPECTION j
SIG E (OWNER OR A Fj T GATE SI NED DEPARTM EN I" DAT
OFFIG/r� �
CITY OF )
EDMONDS
CALL FOR IRELEAS D DY' DATE J
ATTENTION INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE 771-3202 ORIGINAL — File ELLOW — Inspector
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC Jrf%7L� PINK — Owner GOLD — Assessor
Aff 7
CHAPTER 3. f
102.87