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CITY OF EDMONDS ZON NUMBER _1)0(
CONSTRUCTION PERMIT APPLICATION JOB SUITEJAPT#
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
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DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
STATE SURCHARGE
PER IT APPIJCATIOK:I 100 DAYS
PERMIT LIMIT. 1 YEAR - PROVIDED WOR S STARTED WITHIN 180 DAYS
ENS. REVIEW FEES
See BACK OF PINK PERMIT FOR MORE INFO=
-APPLICANT ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
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IN NTEREST. AGREES To DEFEND AND HOLD HARMLESS THE CITY OF
NDSCAPING
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�NDEMNIFY,
EDMONDS. WASHINGTON, TS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
INSPECTION FEE
V CTLYOR INDIRECTLY
ALL CLAIMS FOR DAMAGES OFWHATE ER NATURE. ARISING DIRE
OF THIS PERMIT SHALL NOT BE
CHECK DEPOSIT
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE
EOR REDUCEANY REQUIREMENTOF ANY CITY ORDINANCE
DEEM5DTOMODlFY.WAIV 'S ANY OR01NANCE PROVISION.-
PLAN
RECEIPT
NOR LIMIT IN ANYWAYTKE CITY ABILITY TO ENFORCE
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT: HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN S CORRECT, AND THAT AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
Tl""'Ic I, � jG . p I �1".d b, th.
THE OWINER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATI NO CONSTRUC-
CALL
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TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
OF WASHINGTON RELATING TO
FOR INSPECTION
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IN VIOLATION OF THE LABOR CODE OF THE STATE
WORKMEN'S COMPENS,21NSURANCE AND RCW 18.27. _
OF IALS SIGNATURE DA�/
SIG E OWN ER I E
DATESIGNED
(425)
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11,
771-0220
RELEASED LATE
AlTENTION
EXT 333
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" IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL FIL - YELLOW
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
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