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SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENG. REVIEW FEES
ENG. INSPECTION FEE
;APPLIGANT. ON BEHALF OF HIS OR HER SPOUSE, HEIR% ASSIGNS AND SU CGESORS
N INTEREST, AGREE TO :NDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
16
2 EDMONDSk WASHtNGTONj TS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
ALLCLANSFORGAMA E CFWHATEVER NATURE. ARISING ORINDIRECTLY
X FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIEIRSCMlY SHALL NOT BE
LANDSCAP NG
INSPECTION FEE
PLAN CHECK DEPOSIT
RECEIPT
Q DEEMED To MODIFY. WAIVE OR REDUCE ANY REOUIFEMENTOF ANYCITY OR01NANCE
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TOTAL -AMOUNT DUE
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I HEREBY ACK"OWLEDGI THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
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GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHOR AGENT OF
CONSTRU%
T E OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC)
TH HORIZED THEREBY, NO PERSON WILL E EMPLOY
I ION; AND IN DOING THE WORK ALT RELATING TO
N VIOLATION OF THE LABOR CODE 01 THE STATE OF WASHINGTON
,I;IWIBEN�S COMPENSATION INSURANCE AND POW 18.27�
CALL
FOR INSPECTION
(425)
771-0220
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APPLICATION A "'IR " ",
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7 S TENION_
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I Sp P
CATE OF OCCUPANCY HAS BEEN GRANTED. LED SECTION 109
EXT 333
771-0221
FAX
ORIGINAL - FILE- YELLOW - INSPECTOR
PINK -OWNER GOLD - ASSESSOR