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PERM IT APPLICATION: 160-AYS
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PERMIT LIMIT. 1 YEAR PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG, REVIEW FEES
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NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE
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THAT I HAVT READ THIS APPLICATION, THAT THE INFORMATION
APPLICATION APPROVAL
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PERMIT LIMIT. I YEAR WI
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SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-APPLICANT ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
OF
It
IN NTEREST. AGRE INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY
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2 EDMONDS.WASHINr N ITS
DIRECTLYOR INDIRECTLY
INSPECTION
RECEIPT
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- ALLCLAIMS FOR DAMAGE WHATEVER NATURE. ARISING
PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
FROM THE ISSUANCE OF THIS
I TO MODIFY. WAIVE 0 REDUCE ANY REoUIREMENT OF ANY CITY ORDINANCE
o GM5D
5 E
I NOR LIMIT IN ANY WAY THE CITYPS ABILITY TO ENFORCE ANY ORDINAN
TOTAL AMOUNT DUE
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT HEINFORMAII
APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE OULY AUTHORIZED AGENT OF
Tt,m PPfi..h P-4 -'I .1p.d b, M.
THE OWNE . I AGREE TO COMPLY WITH CITI AND STATE LAWS REGULATING CONSTRUC�
CALL
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TION, AND IN D ING TH WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
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OF WASHINGTON RELATING TO
FOR INSPECTION
k I d d P ... P
N OLAT ON OF THE LABOR CODE OF THE STATE
I W I
WORKMEN S COMPENSATION INSURANCE AND RCW 18.27.
FICI S BNA UP. DATE
I DATE SIGNED
(425)
SIGNATURE (OWPIER OR AG7TI,
771-0220
LEASED By
PXT 333
A17ENTION v
IT IS UNLAWFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221 ORIGINAL FILE YELLOW - INSPECTOR
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109 FAX PINK -OWNER GOLD, ASSESSOR
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