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DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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ENG. INSPECTION FEE
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ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC GSADINGIFILU
BE DONE
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION. STATE SURCHARGE
PER�IT APPUCATIOK:I 190 DAYS
S STARTED WITHIN 'SO DAYS ENG REVIEW FEES
I
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PERMIT LIMIT: 1 IE
SEE BA K OF INK PERMIT FOR MORE INFORMATION
ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
;APPLICANT.
N INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
FROM ANYAbD
I NDSCAPING
2 EDMONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES. AND AGENTS
DIRECTLY OR INDIRECTLY
SPECTION FEE
ALLCLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING
OF THIS PERMIT. ISSUANCE OF THtS PERMIT SHALL NOT BE
PIN CHECK DEPOSIT
RECEIPT
x FROM THE ISSUANCE
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REGUIREMENTOF ANY CITY ORDINANCE
NYORDINANCE ROVISION."
ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE Ally
TOTAL AMOUNT DUE IFE.011'
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATIUN PPROVAL
GIVEN I CDR AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
SER. NO STATE LAW S REGULATING CONSTRUC-
CALL
THIS ppll.ation c,2 2,61219�0d by tho
p.id,
IRECTE TO C
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AND IN DOING THE HORIZED THEREBY, NO PERSON WILL BE EMPLOY D
Bui� .Xllli
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TION ATING
IN V16LATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RE TO
FOR INSPECTION
INSURANCE AND RCW 18.27.
OFFICIAL SIG ATUFI 0 E
(425)
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771-0220
RELEASEDBY ATE
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ATTENTION
IT mUNLAWFULTO USE OR OCCUPY A BUILDI NG OR STRUCTURE UNTIL
771-0 221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
OR, GINAL FILE YELLOW INSPECTOR
- ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK -OWNER GOLD