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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS. SIDEWALKS. DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
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PERMIT APPLICATI N: 180 DAYS
P ED WORK IS STARTED WITHIN 180 DAYS
PERMIT LIMIT. I YEAR "OVID
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
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IN INTEREST. AGREES :NDEMNIlY. DEFEND AND HOLD HARMLESS THE CITY OF
M EDMONDS. WASHINGTON, TS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
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ALL CL�IIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
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RECEIPT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONS TRUC
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OFFICIALS SIGNATURE DATE
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RELEASE BY DATE
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
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ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON I BEHALF F HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
DEFEND AND HOLD HARMLESS THE CITY OF
ENG. INSPECTION FEE
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APPLICATION APPROVAL
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GIVEN S CORRECT AND T14AT HE OWNER, OR THE DULYAUTHORIZED AGENTO'
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. DATE
OFFICIALS SIGNATURE
(425) '�ll n ou�`L b- ILL
GINATURE (OWNER OR AGENT) DATE SIGN—
00 0 DATE
771-0220 �RELE
ATTENTION EXT 333
IT I S UNLAWFUL TO U S E OR OCCUPY A BUILD I NG 0 R STRU CTURE U NT I L 771-022, L ORIGINAL FILE
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- PINK OWNER GOLD-ASSESSO
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX