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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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NAME
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PERMIT
000056
NUMBER
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FLAT NAMEISUBDIVISION NO.
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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GdADINGIFILL
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS. MAROUEES, ETC.) WILL nEOUIRE
SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT APPLICATI N: 180DAVS
PERMIT LIMIT.- I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE 8ACIX OF PINK PERMIT FOR MORE INFORMATION
P PLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
;A THE CITY OF
INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS
AND
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2 EDMONDS. WASHING ON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FRO. ANY
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIAECTLYOR INDIRECT�l
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PLAN CHECK DEPOSIT
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NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
TOTAL AMOUNT DUE
RECE
I HERE Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN'", CoRnEoTANDTHAT I A. THE OWNER, OR THE DULY AUTHORIZED AGENTO'
U�Iil 11910d by th,
oW 'R AGR.ET.�..PLYW'THCI T AND STATE LAWS REGULATING CONSTRUC
THE N Y
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TION;ANDIN DOING THE WORK AUTHDNZED THEREBY. NO PERSON WILL BE EMPLOYED
THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
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IN VI LATION OF THE LABOR CODE OF
WORKMENS COMPENSATION INSURANCE ANDRCW 18.27.
(425)
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771-0221
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ORIGINAL FILE YELLO -INSPECTOR
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