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2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
M SEPARATE PERMISSION. STATE SURCHARGE
PERMIT APPLICATION: 180 DAYS
PERMITLIMIT.1 AR 'PROVIDED WORK IMS STA TED WITHIN 180 DAYS
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SEE BACK OF PINK PERMIT FOR ORE INFORMATION
ENG� INSPECTION FEE
'APPLICANT. NSEIIALll HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
;AF'P�U�C�ATiGk S. To LANDSCAPING
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N OLAT ON OF THE LABOR CODE OF THE STATE DATE
WOR��S COMPENSATION INSURANCE AND RCW 18.27. OPTIC L NATU E
A N E SIGNED
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771-0220 FIELEA E AT
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UNLAWFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
IT IS ORIGINAL - FILE - YELLOW - I SPEC OR
FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
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SEPARATE PERMI EStOAL
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PERMIT APPUCATION: 180 DAYS
P. PER AR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
"T LIMIT., I YE
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'A PUCANT, ON BEHALF OF HIS OR HER SPOUSE, HEIAS. ASSIGNS AND SUCCESORS
P
END INSPECTION FEE
IN INT REST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY Or
E M ANY AND
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EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYE56, AND AGENTS FRO
DIRECTLY OR INDIRECTLY
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ALLCLAIMS FOR DAMAGESOF WHATEVER NATURE. ARISING
OF THIS PERMIT SHALLDNOT BE
R
CHECK DEPOSIT
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE
TYOR IMANCE
ANY REQUIRI.ENT.1 AHICITY ORDINANCE
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DEEMED MODIF,, IVEO REDUCE
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THE CITY'S ABILITY TO ENFORCE ANY OR
0 NORLIMITINANY
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT� AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
CONSTRUC�
THE OWNER, I AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING
NO PERSON WILL BE EMPLOY D
CALL
TION; AND IN 0 ING THE WORK AUTHORIZED THEREBY.
0 NO TEO
OF THE STATE OF WASHINGTON RELATI
FOR.,INSPECTION
IN VIOLATION OF THE LABOR CODE
Wop�pEN;S COMPENSATION INSURANCE AND FEW 18,27.
S, AT 'E I DATE SIGNED
(425)
771-0220
EXT 333
7FENTION
IT IS UNLAWFUL TO USE 013 OCCUPY A 13UILDING OR, STRUCTURE UNTIL 771-0221
\A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
DATE
�ITBACI� III I P=lD
SIDE F�jAr
4'NL,1�� RIEWE. BY
L.A.
PER UBC 108/FINAL INSPECTIC
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