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-1 DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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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
GRADINGIFILL
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARGUEES, ETC.) WILL REOUIRE
:i SEPARATE PERMISSION.
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PERMIT APPLICATION: III DAYS
PERMIT LIMIT: I YEAR � P ROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG, REVIEW FEES
SEEBAC K OF PINK PERMIT FOR MORE INFORMATION
ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
;APPLICANT.
, INTEREST. AGREES TO EMN F DEFEND AND HOLD HARMLESS THE CITY —
LANDSCAPING
EDMOND �NoOFFIGIY�IUS, EMPLOYEES, AND AGENTS FROM ANYAND
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INSPECTION FEE
ALL Cl-Al NIS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
SHALL NOT BE
RECEIPT
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT
DEEMED TO MODIFY. WAIV EOR REDUCEANY REQuIREMENTOF ANYCITYORDMANCE
PLAN CHECK DEPOSIT
0 NOR LIMIT INANYWAYTHE CITY-SABIL-ITY TO ENFORCE ANYORDINANGE PROVISION.-
TOTAL AMOUNT DUE
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'HERE By ACKNOWLEDGE THAT ICATION: THAT THE INFORMATION
HAVE READ THIS APPL
APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT : AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
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THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
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771-0220
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EXT 333
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-
ORIGINAL - FILE - YELLOW - INSPECTOR
GRANTED. UBC SECTION 109
FAX
PINK - OWNER - GOLD - ASSESSOR
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SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ............
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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THIS PERMIT AUTHORIZES ONLT"EWO " NOTED, THIS PERMIT COVERS WORK TO
_ SEDONE ON I.,V.T. PROP'RT NLY ANY CONSTRUCTION ON THE PUBLIC GRAINNGIFILL
L '0
2 DOMAIN I ... SIDEWALKS , .,V._A,., A..bEES, ETC.) WILL REQUIRE
E'..�TE PERMISSION.
URCHARGE
PERMIT APPLICATION: 180DAYS
PERMIT LIMIT. I YEAR ' PROVIDED WORK IS STARTED WITHIN 180 DAYS ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFO MATION
;AP LiCAN1. ON ..— H R HER POUSE,.H.1l.R.SLARSSIGNS AND SUCCESORS ENG. INSPECTION FEE
DEFEND . HARMLESS THE CITY OF LANDSCAPING
N INTEREST. AGREES % OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND INSPECTION FEE
OFWHATEVER NATURE. ARISING DIRECTLYOR INDIRECTLY
5 PERMIT SHALL NOT BE PLAN CHECK DEPOSIT
OF ANY CITY ORDINANCE
ORDINANCE PROVISION.- TOTAL AMOUNT DUE
RECEIPT
RECEIPT -jii
1 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
F
THE OWNER I A. E E To COMPLY WITH CITY AND STATE LAWS REGULATING �E),NPSLTOAYUEC� - CALL
TI.N RK. UTH IZED THEREBY. NO PERSON WILL BE
InIn
In
1,:,`LA`TIGN'.F T L' R D OF THE STATE OF WASHINGTON RELATING To FOR INSPECTION
APPLICATION
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Build nt _ ,I 1 .1
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APPROVAL
p,,,Jt until i,911d by in,
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WORKMENSCO� NSATIONIN NCE AND RCW 1 B.27. FFIC
ERORA SIGNED (425) 1
771-0220 RE By
EXT333
ATTENTION
IT IS UNLAWFUL TO USE 08 OCCUPY A BUILDING OR STRUCTURE UNTII
MADE AND APPROVAL OR A CERTIFI- 771-0221
A FINAL NSPECTION HAS BEEN ORIGINAL-FlLE YELLOW- INSPECTOR
CATE OF] OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK -OWNER GOLD ASSESSOR
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