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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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SEPARATE PERMISSION.
SI ATE SURCHARGE
PERMIT APPLICATION 100AYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 1110 DAYS
ENG, REVIEW FEES
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THIS PERMIT AUTHORIZES ONLY THENIORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PIR OPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ET C.) WILL REQUIRE
SEPARATE PERMISSION.
STATE SURCHARGE
MIT APPUCATIOK:I 180 DAYS
YEPE
PERMIT LIMIT. 1 AR - PROVIDED WOR S STARTED WITHIN 180 DAYS
ENG� REVIEW FEES
SEE SACK OF PINK PERMIT FOR MORE INFORMATION
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-APPLICANT ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
THE CIly
IN INTEREST. AGREESTO INDEMNIFY, DEFEND AND HOLD HARMLESS
EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANYAND
INSPEC71ON FEE
ALLCLAIMSFOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLYOR INOIRECTLY
MOT BE
RECEIPT
FROM THE ISSUANCE OF. THI 5 PERMIT. ISSUANCE OF THIS PERMIT SHALL
DEEMEDT MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANC
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PLAN CHECK DEPOSIT
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NORUMIT
TOTAL AMOUNT 0 E
REC IPT
I HEREBY ACKNOW EDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLII ATION APPROVAL
GIVEN is CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT 01
T" .10-laa 11
T 50.NER. I AGREE TOCOMPly WITH CITY AND STATE LAW S REGULATING CONSTRUC-
CALL
Ou" d,,gOflll.11 11 hiWhll Depuly: and F.. .,.,.id..ad
TH HORIZED THEREBY, NO PERSON WILL BE EMPLOYED
ION; AND'IN DO G THE WORK AUT TON RELATING TO
F . OR INSPECTION
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N ViOLAT ON F THE LABO R CODE OF THE STATE 0 WASHING
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WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
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0 FICIALS SIGNATVRE,
LLTUE" 0 AD
771 -0220
U4
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EXT 333
ATTEN tION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND A ... OVAL OR A CERTIFI,j
UBC SECTION 109 9
ORIGINAL - FILE YELLOW - INSPECTOR
FAX VIC 17 PINK - OWNER GOLD - ASSESSOR
C ATE OF OCCUPANCY HAS BEEN GRANTED.
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