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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
E DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLI C
DOMAIN (CURBS. SIDEWALKS. DRIVE AYS. MARQUEES, ETC.) WILL RED IRE
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SEPARATE PERMISSION.
PE.MITAPPLICATID-: 110 DAYS
PERMIT LIMIT: 1 YEAR - PROVIDED ORK IS STARTED ITHIN 1 ED DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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PLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
NP , S, D
INTEREST. AGREES TO �TNGEMN,.,y ENO AYWEoES". IAINI..AF.L.S THE CITY OF
E EDMo`oS,WASHI0 TON, OFF �D. EM'Lo AGENTS FROM ANY AND
A A A
LLCLAIMSFORD M GESOF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THEISSUANC E OF THIS PERMIT ISS ANCE OF THIS PERMIT SHALL NOT BE
WAIVE OR REDUCi ANY UREQUIREMEINT OF ANYCITY ORDINANCE
DEEMEDTOMODIFY�
0 NOR LIMIT INANYWAYTHE CITYSABILITY TO ENFORCE ANYORDINANCE PROVISION,
REMARKS
ROGRESS INSPE IONS PER UBC 1081FINAL INSPECTION REQ'D
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VALUATION
FEE
PLAN CHECK FEE
BUILDING
PLUMBING
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STATE SURCHARGE
ENG, REVIEW FEES
LANDECA ING
INSPECTION FEE
PLAN CHECK DEPOSIT
___ __
TOTAL AMOLINT DUE
R IF.
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN I CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIIED AGENT OF
6 CONSTRUC
LAWS REGULATING
CALL
Th,, appl,11111— por-t llgl.d by.-
THE OWNER. I AGREE TO COMILY WITH CITY AND STATE
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NO PETS N WILI BE
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TIOW; AND IN GOING THE W RK AUTHORIZED THEREBY. EMPLOYED
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FOR INSPECTION
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IN VIOLATION OF THE LABOR CODE
WORKMEN S COMPENSATION INSURANCE AND RCW 18.21
OFFICIALS RE DATE
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771-0220
LEASED BY
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ATTENTION
IS UNLAWFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
IT
BEEN MADE AND APPROVAL OR A CaRT19-
ORIGINAL - FILE - YELLOW - INSPECTOR
A FINAL INSPECTION HAS
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
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CITY OF EDMONDS NUMBER
SUITUAPTI
CONSTRUCTION PERMIT APPLICATION 'A'D'DFED.
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NAME YE 0 No 0
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REMARKS
ADDRESS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAIN111
CITY ZIP TELEPHONE
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NAME
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC GRADINGIFILL
DOMAIN (CURBS. SIDEWALKS. DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
STATE SURCHARGE
PE MIT APPLICATION: 1-0 DAYS
R7
PERMIT LIMIT. I YEAR PROVIDED WORK IS STA TED WITHIN 180 DAYS
FOR MORE INFORMATION
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT
7F
CANTONBEHAL 0 S POUSE, HEIRS, ASSIGNS AND SUCCESORS
FHI CIPHERS
;A IPLI
N NTE EST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
R
S ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
k ED No WASHINGTON.
Mo
INSPECTION FEE
ALLCLAIMS FOR DAMAGESOF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FR M THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
DEOEMED TO MODIFY, WAIVE 0 REDUCE ANY REQUIREMENT 01 ANY CITY ORDINANCE
11...
NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANY ORDIN
TOTAL AMOUNT DUE
I HERE Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION� THAT THE INFORMATION
!121_15A�1�14 APPROVAL
GIVENB RECT, AND T AT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
IS Co RI
hA
a ppl;,. � I a, , p-it u,l,l a,gned by thO
THE OWNER. AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
EMPLOYED
CALL
.a OIS"I 0, Iajm� Gamy: a.d F,ms am p.m. ,d
B.ildl
TION. AND IN DOING THE WORK AUTHORIZED THERE BY. NO PERSON WILL BE
WASHINGTON RELATING TO
FOR INSP�ECTIONJ ma,apt ia .�am,,Ibdg.da, pace provaled.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27�
FFICIALS SIGNtRE DATE
(o ATE§g
(425)
El,,�URE
771-0220
RIELEASED BY
EXT
ATTENTION
IT IS UNLAWFULTO USE On OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL ORJA CERTIFI-
ORIGINAL FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 09
FAX
PINK -OWNER GOLD ASSESSOR
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