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PERMIT EXPIRES
PERMIT
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SURCHARGE
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END REVIEW FEES
SEE BAC K OF PINK PERMIT FOR MDRE INFORMATION
lA ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
END INSPECTION FEE
;APPLICANT,
N INTEREST, AGREES TO INDEMNIF Y. DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENI I FROM ANY AND
INSPECTION FEE
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I HEREBY ACKNOWLEDGE THAT I HAVE REABTHIS APPLICATION. THAI THE INIORIJADON
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GIVEN IS CORREC THE DUt-Y AUTHORIZED AGENT 01
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771-0220
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TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
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PERMIT 2004-91
CITY OF EDMONDS
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BUILDING
PLAN CHECK NO: �VESTEI -11
PLUMBING
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THIS PEIMIT AUTHORIZES ONLY THE WORK NOTED , THIS 118M'T COVERS WORK TO
BE .. E ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
..AN ICUR.S. SIDEWALKS, DRIVEWAYS MA QUEES, ETC.) WILL REQUIRE
SEPARATE PERWISSION.
SURCHARGE
PERMIT APPLICATION: HIO DAYS
PERMIT LIMIT. AR, PROVIDED WORK IS STARTED WITHIN 180 DAYS
I YE
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUC ESORS
THE CITY OF
AND HOLD HARMLESS THE CITY OF
ENG, INSPECTION FEE
L NDSCAPING
IN INTEREST. AGREES TO :NDEMNIFY, DEFEND
EDMONDS, WASHINGTON. TS OFFICIALS. EMPLOYEES, AND AGENTS FRO. ANY AND
INSPECTION FEE
ALLCLAIMS FOR DAMAGESOFWHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
CEIPT
FR M THE ISSUANCE 01 THI S PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE
PI AN CHECK DEPOSIT
DEOEMEDTOMODIF WED REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
PROVISION.*
YAW
RECEIP
N ORLIMITINANY THE CITY'S ABILITY TO ENI�ORCE ANY ORDINANCE
TOTAL AMOUNT DUE
S2_
THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
AL
APPLICATION,,�,,�
I HEREBY ACKNOWLEDGE
GIVEN IS CORRE CT. AND THAT I AM THE OWNER OR THE DULY AUTHORIZED AGENT 01
Thl, IpPlicatl i� PI .7RO
AWRGULA NGCONSTRUC-
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE L.
CALL
11 hi.11,11 DOP
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TION; AND IN DOING THE WORK AU HORIZED THEREBY. PLOYED
RELATING TO
FOR INSPECTION
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IN VIOLATION 0, T. E LABOR CODE OF THE STATE OF WASHINGTON
WORKMEN'S COMPENSATION INSURANCE AND RCW 16.21�
OF CIA S IGNATURE
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(425)
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SIG
771-0220
ATE
RELEA E
EXT 333
7
ITIS UNLAWFULTOUSEOR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE E LOW -IN PECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED . UBC SECTION 109 '
FAX
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