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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PROPERTY TAX ACCOUNT PARCEL NO.
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STATE SURCHARGE
PERMIT APPLICATION: 180 DAYS
WITHIN 180 DAYS
ENG, REVIEW FEES
PERMIT LIMIT, I YEAR - PROVIDED ORK IS STARTED
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
_,CANT�,OAN�BEHA,T.0, HIS O�R POUSE. HEIRS. ASSIGNS AND SUCCESORS
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ANY RE.UIFE.ENT OF ANY CITY ORDINA.C�
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SIGNATURE 10—WNER OR GEN
771-0220
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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
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DESCRIPTION OF WORK I -
A field inspection was conducted to determine compliance with approved plans. 'Final approval. denotes that
there are no objections from the above signed Department to the granting of
)�_Finai approval of the described work
Bonds associated with the project may be released
GRANT FINAL PROJECT APPROVAL
GRANT FINAL PROJECT APPROVAL wrrH CONDITIONS NOTED
OUTSTANDING ISSUES
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CONSTRUCTION PERMIT APPLICATION
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I SEPARATE PERMISSION.
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STATE SURCHARGE
PERMIT APPLICATI IN: 1.a.AYG
PERMIT LIMIT. I YE A - PRoVjD D WORK IS STARTED WITHIN 180 DAYS
An E
ENG. REVIEW FEES
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BE A. RMIT FOR MORE INFORMATION
SEE BACK OF PINK PE
ENG. INSPECTION FEE
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS A SIGNS A
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IN NTEREST. AGREES To INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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EEMED TO MODIFY, WAIV OR REDUCEANY RSOUIREMENTOF ANY C
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NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANYoRDINAN's
ALAMOUNTDUE
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ACKNOWLEDGE THAT: HAVE READ THIS APPLICATIONI THAT THE INFORMATION
APPLICATION
APPROVAL
I HEREBY
GIVEN IS CORRECT.ANDTHAT AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
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THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
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TION: AND IN DOING THE WORK AUTHORIZED THEREBY. No PERSON WILL BE EMPLOY ED
RELATING To
R INSPECTION
... �pli�.�k�,,todged��spacopmvidGd,
III VIOLATION OF THE LAGOA CODE OF THE STATE OF WASHINGTON
WORKMEN'S COMPENSATION INSURANCE AND ACW 16.27,
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SIGNATURE (OWNER OR1jGE
(425)
�NAT
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AELEA S DBY
�CWtNTION
EXT 333
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDIN G OR STRUCTURE UNTIL
771-0221
HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE - YELLOW - INSPECTO
A FINAL INSPECTION
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109
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