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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 GRADINGIPILL
DOMAIN (GURISE, SIDEWALK% DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION,
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PERM ITAPPLICATION. 180DAYS
PERMIT LIMIT. I YEAR , PROVIDED WORK IS STARTED WITHIN TOO DAYS ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'A SIGNS AND SUCCESORS
PPLICANT. ON BEHALF OF HIS OR HER SPOLSE� HEIRS. AS
IN INTEREST, AGREES To :NDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
AND
LANDSCAPING
I EDMONDS, WASHINGTON TE OFFICIALS, EMPLOYEES, AND AGENTS FRO. ANY
Al-l-CILAWS FORDAMAGEiI OF WHATEVER NATURE, ARISING ORECTLYOR INDIRECTLY
INSPECTION FEE
RECEIPT
FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
A
D EMED TO MODIFY, VAMVE OR REDUCE ANY EOUIREMENTOF ANY CITY ORDINANCE
ANY ORDINANCE PROVISION
RECEIPT
NE
OR LIMIT IN ANY WAYTHE CITY'S ABILITY TO ENFORCE
TOTAL AMOUNT DUE
I HEREBY ACKNOW'EOGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLIC ION APPROVAL
GIVEN IS CORREC AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
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THE OWNER. I AG EE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUG
CALL
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TION; AND IN DOING THE WORK AUTHORIZED THEREBY. No PERSON WILL BE EMPLOYED
WASHINGTON RELATING TO
FOR INSPECTION
IN VJOLATtO B CODE OF THE STATE OF
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OFFICIA BE NA TE
WOHKMENSCOM!�p
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771-0220
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EXT 333
ATTENTIaN
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFk
ORIGINAL -FILE yELOW,NSPECT.T
ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
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