20000398.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIG SAN S ES RE
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I HERE ACKNOWLEDG E THAT I H AVE RE AD TH 1�� AIPTICATIU-LNY THAT T.- E,1E,,F-- MAT' -
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CITY OF EDMONDS
NUMBER
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T PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 160 DAYS
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SEE BACK OF PINK PERMIT -OR MORE INFORMATION
ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SLI CESOBS
�NG, INSPECTION FEE
;APPLICANT,
, INTEREST. AGREES TO INDEMNIFY, DEFEND AND HUD HARMLESS THE CITY OF
ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
LANDSCAPING
INSPECTION FEE
7 EDMONDS, WASHINGTON�
=� ALLCLAtMSFORDA AGESOPWHATEVES NATURE, ARISING DIRECTLYOR INDIRECTLY
THIS PERMIT SHALL NOT BE
CHECK DEPOSIT
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DEEMED To MODIFY. WAIVE
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TOTAL AMOUNT DUE
RECEIPT
READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION
APPROVAL
IHERq Y ACKNOWLEDGE THAT I HAVE
GIVEN' RECT, AND THAT I AM THE OWNER 08 THE DULY AUTHORIZED AGENT OF
IS COR STAT
THE OWNER, I AGREE To COMPLY WITH CITY AND E LAWS REGULATING CONSTRUC,
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CALL di,g Ojj,.j,I his- o,j, ��d F — P-ld nd
TION, AND IN DOING THE WORK AUTHORIZED THEREBY, NOPERSONWILLBE EMPLOYED
THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
IN VIOLATION OF THE LABOR CODE OF
WORKMEN'$ COMPENSATION INSURANCE AND ROW 18.27,
U14 AG
rOWNER,0
DAT71GNED
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771-0220-, EASE. Y DATE
ATTENT1014
EXT'333 jzj�
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UNLAWFULTO USE OR OCCUPY ABUILDING OR STRUCTURE UNTIL 771-0221
ITIS
FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI
ORIGINAL -FILE - YELLOW -INSPECTOR
A
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER GOLD -ASSESSOR
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