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PERMITAPPLICATI N: ISODAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN lfl� DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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'APPLICINT. 01 BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
AGREES TO INDEMNIFY, DEPEND AND HOLD HARMLESS THE CITY 01
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IHERGBY ACKNOWLEDGE THAT: HAVgRE.ADITHISAPPLICATICH: THAT THE INFOR.ATION
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WORKMENS COMPENSATION INSURANCE AND RGA? 111,21
FICIALS SIGNA DATE
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771-0221
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CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 09
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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
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
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GRADING*ILL
STATE SURCHARGE
PERMIT APPLICATION: IBODAYS
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PERMIT LIMIT: I YEAR -PROVIDED WOR SSTARTEOWITHIN 100DAYS
SEE SACK OF PINK PERMIT FOR MORE INFORMATION
ENG. REVIEW FEES
F HIS IRS, ASSI.IIS AND SUCCES.FS
PLI "I"y" 'FOUSE
.'NTERES NOE . E EN �N. ..L EBB THE CITY OF
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2 EDMONDS. WASHINGTON. ITS FICIALS, EMPLOYEES, AND AGENTS FROM ANYAND
ALLOIjdMS FOR DAMAGES OFWHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
m DEEMEDT MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0
0 NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.
LANDED
INSPECTION FEE
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
REC&
I 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
THEOWNEA� I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOY ED
I N VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RE ATING TO
WORKMEN S COMPENSATION INSURANCE AND RCW 18.27,
L��ATI SIGNED
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APPLICATION APPROVAI
The IPPI't.t"-,s net. 1,9nld by In,
CALL 8,,Id,ng Olfi5 1, hl-1, Deputy: and F p,,d. and
FOR INSPECTION ,pt I, ,kIodgld in p,,* p,,,,d,d.
� __0 FICIALS SIGN E DATE
(425) C. �� I I, 1w
771-0220 RE�E�S�D BY DAIIE
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
HAS BEEN MADE AND APPROVAL OR A CERTiFl-
EXT 333
771-0221
ORIGINAL - FILE - YELLOW - INSPECTOR
A FINAL INSPECTION
CATE OF OCCUPANCY HAS BEEN GRANTED. LIBC SECTION 109
FAX
PINK - OWNER - GOLD - ASSESSOR
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