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DATE RECEIVED PERMIT EXPIRES 10 - ty'
USE PERMIT
CITY OF EDMONDS ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITFJAPT.
ADDRESS
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MECHANICAL
THIS.PFRMIT AUTHg,RIZEES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
E DONE ON P VAT PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIF(LL
2 SISSION. RE
DOMAIN (CURBS, SIDEWALKS, DRIVEWAY , MARQUEES, ETC.) WILL REOUl
SEPARATE PER
9T� RCHARGE
2 PE MIT APPLICATION2 III DAYS
PERMIT LIMIT. I YEAR! PROVIDED WORK IS STARTED WITHIN 180DAYS
END, REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
;APPLICANT. ONSEHALFOFHI 09 HER SPOUSE, HEIRS. All NS AND SUCCESORS
DEFEND AND HOLD HARMLESS THE CITY OF
ENO. INSPECTION FEE
LANDSCAPING
13 N INTEREST. AGREES TO INDEMNIFY.
m EDMONDS. WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
INSPECTION FEE
I. RE. ARISING DIRECTLY OR INDIRECTLY
ALL CLAIMS FOR DAMAGESOF WHATEVER NATU
THIS PERMIT SHALL NOT BE
RECEIPT
PLA CHECKDEPOSIT
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF
DEEMED To MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY OPOINAN C
0 NOR LIM T IN ANY WAY THE CITY LIT TO ENFORCE ANY ORDINANCE PROVISION.
I 'SABI Y
PT
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIRS APPTLICIATION- 'HAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNE . OR H OU Y AUTHORIZED AGENT OF
This .,.� I. . psh,h u�fil .1p.d i,y th.
applic
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTAUC
BE EMPLOYED
CALL d �a Olfi-1,,r
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TION: AND IN D ING fHE WORK AUTHORIZED THEREBY. NO PERSON WILL
0 RELATING To
WASHINGTON
FOR INSPECTION
IN VOLATI ON OF THE LABOR CODE OF THE STATE OF
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
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OFFIJSIG UR E
,.NEG
DATE SIGNED
(425)
SIGNATURE,OWNIRORAGINTI
-3-,o
11 1 -Lifew RELEASED By
EXT 333
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221 ----
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
OnIGINAL-FLE YELLOW. INSPEClOR
GOLD - ASSESSOR
A FINAL
BEEN GRANTED. UBC SECTION 109
FAX PINK - OWNER
CATE OF OCCUPANCY HAS
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