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IT IS UNTIILUALFINAL IAVIFULNSPECTION HAS BEEN MADE USE OR OCCUPY A ANDNG OR APPROVALURE OR TT 1 —o22U
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SECTION 109
10267
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Plan Check No.
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This Permit covers work to be done on private property ONLY.
GRADINGMILL
Any construction on the public domain (curbs, sldewPlks,
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driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
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Permit Application: 180 Days
STORM DRAINAGE FEE
Permit Llmit:1 Year- Provided Work Is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns and
ENG. INSPECTION FEE
m successors in Interest, agrees to Indemnity, defend antl. hgld. _
W harmless the CityL�i=Edme4ft Washington, Its offldials,'
for damages of
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employees, and agents from any and all claims
< Whatever nature, arising directly or 1,Tdirectly from the Issuance
Issuance this shall not be deemed to
PLAN CHECK DEPOSIT
of this permit. of permit
omodify, waive or reduce any requirement of any city ordinance
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TOTAL AMOUNT DUE
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provision."
I hereby acknowledge that I have read this application; that the ATTENTION
APPLICATION APPROVAL
Information given 19 correct; and that I am the owner, or the duly
authorized agent GI the owner. I agree to comply with city and
THIS PERMIT
This application is not a permit until
slate laws regulating construction; and In doing the work autholiz.
AUTHORQEs
THE
signed by the Building Official or, his/her
ed thereby, no person will be employed In violation of the Labor
ONLY
WORK NOTED
Deputy; and fees are pai4 antl receipt is
Code of the State of Washington relating to Workmen's Compensa•
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acknowledged in space provided.
.triii" surance r d 8.27.
ATD E IOWN R AGENTI GATE SIGNED
INSPECTION
DEPARTMENT
OFFICI S TUBE DATE
3(�
CITY OF
EDMOND S
�l
CALL FOR
LEAS¢ BY
ATTENTION
INSPECTIION!
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
BEEN MADE AND APPROVAL OR
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17RIGINAL - F,Ie YELLOW - Inspector
UNTIL A FINAL INSPECTION HAS
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. - UBC
!
/
SECTION 109
10247
PINK - Owr.er GOLD - Assessor