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CITY OF EDMONDS
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STATE SURCHARGE
PERMIT APPLICATION! '80 DAYS
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ENO, REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
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ATTENTION
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771-0221
�YELLOW
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
NAL - FILE - INSPECTOR
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BE DONE ON PRIVATE PROPER" ONLY. ANY CONSTRUCTIO
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DOMAIN (CURBS, SIDEWALKS. DRIVE . MARQUEES, ETC.) WILL REGUIRE
SEPARATE PERMISSION.
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STATE SURCHARGE
11. APPLICATION: 180 DAYS
IT
PERMIT LIMIT. I YEAR PROV'CEp WORK IS STARTED WITHIN 18D DAYS
ENO REVIEW FEES
SEE BACKOF PINK PERMIT FOR MORE INFORMATION
�I E N S
ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
NO INSPECTION FEE
ENO. INSPECTION FEE
;APPLICANT,
I L BE T I
N INTE EST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
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LANDSCAPING
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EDMOND , WASHINGTON, ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
INSPECTION FEE
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ALLCLAIMS FOR DAMAGESOFWHATEVER NATURE, ARISING DIRECTLYOR INDIRECTLY
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X FROM THE ISSUANCE OF THIS PERMIT ISSUMCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
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DEEMED TO MODIFY. WAIVEOR REDUCE ANY REOUIFIEMENTOFANYCITY ORDINANCE
-
NOR LIMIT IN ANY WAYTHE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.
TOTAL AMOUNT DUE
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN 15 CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
TION: AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTII
WOSKMEWS COMPENSATION INSURANCE AND RCW 1 &27.
SIGNAJP�7E (0771 AL DATE 111113
(425)
,
:1 1/
771-0220
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ATTENTION
EXT 333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING 08 STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL 08 A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
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