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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PRCPERTI ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS. MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERM IT APPLICATI N: 180DAYS
PERMIT LIMIT, 1 YEAR, PROVIDED WORK 15 STARTED WITHIN 180 DAYS
SEE BAC K OF PINK PERMIT FOR MORE INFORMATION
;A PUCANT ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUccEsoRs
P CITY OF
N INTEREST AGREES TO INDEMNIFY. DEFEND AND HQLD HARMLESS THE
2 EDMONDS. WAS HINGTON. ITS OFFICIAL�. EMPLOYEES, AND AGENTS FROM ANY AND
ALL C Al.s FOR DAMAGES OF WHATEVER NATURE, ARISING DIHECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
D EMED TO MODIFY, WAIVE OR REDUCE AN REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANYWAY THE CITY S ABILITY TO ENFORCE ANY ORDINA CEPROV15ION.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION� THAT THE INFO MATION
GIVEN IS CORRECT. AND THAT I A. THE OWNER. OR THE DULY AUTHORIZED AGENT OF
T E OWNER� I AGREE TO COMPLY WITH CIT AND STATE LAWS REGULATING CONSTRUC
H THEREBY NO PERSON WILL BE EMPLOY D
TION: AND IN DOING THE WORK AUTHORIZEDE STATE OF WASHINGTON FEI ATING E
IN VIOLAT ION OF THE LABOR CODE OF TH TO
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFl- ORIGINAL FILE YELLOW INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK -OWNER GOLD ASSESSOR
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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. SIDEZI.KS. DRIVEWAYS. MAROUEES, ETC.) WILL REOUIRE
SEPARATE PERMISSION.
GRADINGIFILL
STATE SURCHARGE
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PERMIT APPLICATI N: 180 DAYS
PERMIT LIMIT'. I Y -An - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE 5ACFK OF PINK PERMIT FOR MORE INFORMATION
'APPLICMT, ON BEHALF 01 HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORE
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANYAND
EDMONDS. WASHINGTON,
1. ALL CLAIMS FOR DAMAGES OFWHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
- FRO THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
9 DEEMEDTO MODIFYWAIVEO REDUCE ANY REQUIREMENTOF ANY CITY ORDINANCE
0 NORLIMIT IN ANY WAYTHE CITY'S ABILITY TO ENFORCE MY ORDINANCE PROVISION.
END. INSPECTION FEE
LANDSCAPING
INSPE27ION FEE
PLAN CHECK DEPOSIT
TOTAL AMOUNT
RECEIPT
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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
THEOWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE LEMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RE ATING To
WORKMEN'S COMPENSATION INSURANCE AND RCW IB.27.
APPLICATION APPROVAL
CAL d,� 11 hls�01 Dop,ty: .,d Fo,, ,, PlId. Ild
FOR INSP TION -PI ol 1-11T0,191— 1p.ce pl.ldld.
F CIALS SIGNATU E DATE
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SIGNATU RE_(GWNER OR AGO
(425)
771-0220
JELEAIED BY
A17ENTION EXT 333
IT IS UNLAWFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL m FILE YELLOW - INSPECTOR
A FINAL INSPECTION
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER GOLD - ASSESSOR