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CITY OF EDMONDS
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PEAMIT APPLICATION; 180 DAYS
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END REVIEW FEES
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— ----------- 7- -7
ATE RECEIVED
44 PERMIT EXPI13ES,
CITY OF EDMONDS
�84 PERMIT
NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB 0 SlITEAPT'
ACOR
AM NAMEOFBUSINESS
PLAT NAMEISUBDIVISK)N NO, LOT NO. LID NO,
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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
9 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
:3 SEPARATE PERMISSION,
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GRADINGIFILL
STATE SURCHARGE
PERMIT APPLICATION; 180 DAYS
PERMIT LIMIT.- I YEAR � PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
HIS OR HER SPOUSE, HEIRS, A SIGNS AND SUCCESORS
Di INTERES . A REES T NDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
!� IN I ENT$ FROM ANY AND
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RECEIP
PLAN CHECK 0 POSIT ZJ
FIT THE ISSUA S F THIS PERMIT.
D EDT DIFY, AIVE R REDUCE ANY REQUIR ENIENTOF ANY CITY ORDINANCE
N LIMIT ANY AY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.�
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T'll S AIPLICATI. N THAT THE INFORMATION
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IN VIOLATI'ONN) OF CHE LABO rkTE OF WASHINGTON FOR INSPECTION
WO M COMPENSATION
DATE SPNED
OFlIc SSI URE DATE
(425)
SIGN NE
771-0220 E By
-ATTENTION
EXT 333
IT IS UNLAWFU A BUILDING OR STRUCTURE UNTIL
L To USE OR OC 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APP ROVAL OR A CERTIFI-
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