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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PERMIT APPLICATI N: IGO DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
L
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ON BEHALF OF HIS OR HER SPOUSE. AEIRS� ASSIGNS AND SUCCESOR5
A F.'
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ENG. INSPECTION FEE
;APPLICANT,
IN INTERESi. AGREES TO ;NDEMNIFY. DEPEND AND HOLD HARMLESS THE CITY OF
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NE TO o PROVISION."
N F " 'TN Y W Y 'S ABILITY TO ENFORCE ANY ORDINANCE
0 NOR LWIT IN ANY WAY THE CITY
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVEN I CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZE. AGENT OF
S
THE OWNER. I AGREE TO COMPLY WITH CITY AND S E LAWS REGULATING Cor,iSTRUC
CALL
EMPLOYED
TION; AND IN D ING THE WORK AUT..FIlED THEREBY, NO PERSON WILL BE L G TO
OF WASHINGTON RE ATIN
FOR iNSPECTII
IN VIOLATION OF THE LABOR CODE OF THE STATE
WORKMENS COMPENSATION INSURANCE ANDRCW 111.27,
DATE S DIKED
(425)
UIRE IOWNER 0
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771-0220
EXT 333
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
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3 SEPARATE PERMISSION.
URCHARGE
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PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT. I YEAR - PROVIDED W RK IS STARTED WITHIN IOU DAYS ENO. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
END INSPECTION FEE
'A PLI NT. ON BE OFIIISOR ER N%�1.110SCA S AND SUCCESORS I I . I
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TOTAL AMOUNT DUE
00. A'll READ THIS AIPUCAIMN: THAT THE INFORMATION APPLICATION APPROVAL
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IN Vt LATI F THE SOR CODE 0 THE
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771-0220
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IT is UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNT! IL 771-0221?p, YELLOW - INSPECTO
BEEN MADE AND APPROVAL OR A CERTIF ORIGINAL - FILE
A FINAL INSPECTION HAS PINK OWNER GOLD ASSESS R
HAS 13EEN GRANTED. UBC SECTION 109 FAX 0
CATE Of OCCUPANCY