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BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC GRADINGIFILL
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STATE SURCHARGE
PERMIT APPLICATION: IJBIDAYS
YEAR -PROVIDED WO K IS STARTED WITHIN 180 DAYS
PERMIT LIMIM I R END, REVIEW FEES
SEE BACK OF P114K PERMIT FOR MORE INFORMATION ENO INSPECTION PEE
ON BEHALF OF HIS OR HER SPOUSE� HEIRS, ASSIGNS AND SUCCESORS
;APPLICANT
N NTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF -�BSCAT`IM
FROM ANYAND
m EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS G�fi
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PROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PLAN CHECK DEPOSIT
DEEMED TO MODIFY, WAIVE OR REDUCEANY REQUIREMENT OF ANY CITY OR01NANCE
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I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPILICATION� THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TOCO LY WITH CITY AND STATE S REGULATING CONSTRUC
NOAWERSON
CALL
TION: AND IN DOING THE WORKAUTHORIZED THEREBY, WILL BE EMPLOYED
STATE OF WASHINGTON RELATING To
FOR INSPECTI,
IN VIOLATION OF THE LABOR CODE OF THE
WORKMEN'S COMPENSATION INSURANCE AND RQW 18,27.
ATE SIG ED
(425)
771-0220
_W17TENTION 7-7
EXT 333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTUREUNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
APPLIC ION APPROVAL
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