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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
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SIDEWALKS, DRIVIEWAY , MARQUEES. ETC.) WILL REOUI
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SEPARATE PERMISSION.
9� SU CHARGE
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT. I YEAR. PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. REV12W FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-APPLICANT, ON 69HALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND S CCESORS
ENO. INSPECTION FEE
IN INTEREST. AGREES TO DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
;NDEMN"Y'
2 EDMONDS. WASHINGTON. TSOFFICIALS. E.IL.IEEE. AN. AGENTS FROM ANY AND
INSPECTION FEE
I ECTLYOR INDIRECTLY
ALLCI-AWS FOR DAMAGESOF WHATEVER NATURE, ARISING DIRECTLYOR INDIRECTLY
NOT BE
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x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL
POSIT
PLAIN CHECK DEPOSIT
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDIMANC
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NOR LIMIT IN ANY WAY THE CITY'S ABILITY To ENFORCE ANY ORDI NANCE
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THI S APPLICATION. THAT THE INFORMATION
GIVEN IS CORRECT; AMID THAT I AM THE OWNER. OR THE DULYAUTHORIZED AGENT OF
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS EGULATING CONSTRUC.
WILL BE
CALL
TION, AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON EMPLOYED
OF WASHINGTON RE ATING TO
FOR INSPECTION
IN VIOLATION OF THE LABOR CODE OF THE STATE
WORKMEN'S COMPENSATION INSURANCE ANDRCW IB,21.
DATE SIGNED
(425)GENT
771-0220
EXT 333
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
VALUATION I FEE
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