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BE PERMIT
CITY OF EDMONDS ONE Ks— 12— NUMBER
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VALUATION FEE
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BUILDING
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THIS PERMIT AUTHORIZES ONLY THE WORK ED. THIS PERMIT COVERS WOR
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
MAROUEES, ETC.) WILL REQUIRE
GRADINGIFILL
2 DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS.
:5 SEPARATE PERMISSION.
STATE SURC14ARGE
PERM T APPLICATION: 180 DAYS
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PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITH IN 180 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
I APPLICANT. ON BEA� F HISOR HER SPOUSE. HEIRS. AS"ll NSANDSUCCESORS
LFo T14E CITY OF
ENG, INSPECTION FEE
IN INTERESL AGREE T D INDEMNIFY. DEFEND AND HOLD HARMLESS
EMPLOYEES. AND AGENTS FAD" ANYAND
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INSPOCTIO FEE
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F _ ANY CITY ORDINANCE
PLAN CHECK DEPOSIT
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APPLICATION APPROVAL
I AER6BY ACKNOWLEDGE THAT I HMAVIE READ
THAT, A 0 RATHEDULIA.1-11--�.ENT.1
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NGION RELATING TC)
FOR INSPECTION p",
IN VIOIAtION OF THE LABOR CODE OF THE STAT OF WASIN
WOAKMEN!j COMPENSATION INSURANCE ANDRCW 111,27,
OFFICIAL. I NAT TE
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A17ENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INS ECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
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ORIGINAL - FILE YELLOW INSPECTOR
GOLD - ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109
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