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YATE RECEIVED
PERMIT EXPIRES
US" PERMIT
CITY OF EDMONDS ZONE NUMBER 7—oo 332-
CONSTRUCTIOrIl PERMIT APPLICATION <& ILP SUIT APTI
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DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, CTC.) WILL REQUIRE
SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT:APPLICATIONI I-ODAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 160DAYS ENG. REVIEW FEES
SEE BACK OF P114K PERMIT FOR MORE INFORMATION
ENG. INSPECTION FEE
;APPLICANT. ON BEHALF OF HIS OR VIER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
N NTEREST AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
IN F, CENTS FROM ANY AND
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ALLCLAIMS FOR DAMAGESOF WHATEVER NATURE, ARISING Ol
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT
DEEMEDTO MOOIFYWAIVE OR REDUCEANY REOUIRE.EI,IT OF ANY CITY ORDINANCE
0, NOR LIMIT IN ANYWAYTHE CITY SABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
TOTAL AMOUNT DUE
F-EIPT
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IR
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIOK THAT THE INFORMATION
I AM THE OWNER OR THE OULY AUTHORIZED AGENT OF
APPLICATION
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GIVEN IS CORRECT. AN .1
THEO NER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGUIAI ING CONSTRUC Tz� IPPI1111- 11 a P 2uty.. -,J F.I. d, .,d
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ION: AWND IN D ING THE WORK AUTHORIZED THEREBY. N 01, .11'."2
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IN VIOLATION 001 THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMENS COMPENSATION INSURANCE AND RCW 18.21. (425) IDIFICIA G SIGN, U
45 1 DD
771-0220 RELE SED BY
ATTENfION EXT 333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221 L-
A FINAL INS P ECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI ORIGINAL PILE YELLOW- INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK - OWNER GOLD - ASSESSOR