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I tl)ATC RECEIVED PE�M(TEX'PIRES
PERMIT
CITY OF EDMONDS NUMBER 41_DOLJ��o
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'.NSTRUCTION PERMIT APPLICATION JOB
ADDRESS
ADDRESS
CITY
NAME
ADDRESS
CITY
PLAT IIMEIIUBDIVIS'.I4 NO LID N.,
LOT LID FEE S
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P AMIT APPLICATION: 180DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 04YS
SEC BACK OF PINK PERMIT FOR MORE INFORMATION
ENG. REVIEW FEES
ENG. INSPECTION FEC
P LICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
A P
IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CI I I Ul
X EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
AULCLMMSFOR DAMAGESOFW HATEVER NATURE, A91SING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMCD To MODIFY. WAIVE OR REDUCE ANY REOUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION,�
LANDSCAPING
INSPECTION FEE
RECEIPT
SIT
RECEIPT
TOTAL AMOUNT DUE
APPLIC ION APPROVAL
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I HER58Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE NIORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERS. WILL BE 'm'LOY"
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING To
WORKMEN S COMPENkTIONINS4N=D 1
771-0220 ELEA E By ATE
EXT 333
ENTiON
IT IS UNLAWFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
CERTIF!- ORIGINAL - FILE YELLOW - INSPECTOR
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A PINK - OWNER GOLD � ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX
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