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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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THIS PERMIT AUTHOR1.!I .1,11 THE WORK NOTED. THIS PERMIT COVERS WORK TO
I;:1 BE DONE ON IRIVA"D PROPERTY .111 ANY CONSTRUCTION ON THE PUBLIC
DO. A'. .R.. B EWALKE. DRIVEWAYS, MARGUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION,
I:
PERMIT APPLICATIO : 1-0 DAYS
PROVIDED ORK IS STARTED WITHIN I BO DAYS
PERMIT LIMIT. I YEAR W
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
PPUCANT, ON BEHALF 0 F HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
;A
N INTEREST. AGREES To INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY
AND AGENTS FROM ANYAND
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2 EDMONDS, WASHI ITS OFFICIALS, EMPLOYEES.
TMOFINHATIEV"' OATUR ARI�INGDIHEOILYOPINDIRICTI-1
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ALL �IMSF "IMAGE �EPERM EU E . IS PERMIT SHALL NOT BE
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FROM THE IS -CE OF T I
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Y W IV OR EDUCE AN FANY ITYORDINANCE
DEEMED OMODIF A E PROVISION."
H B ABILITY,. E N 'OR OE ANY RDINANCE
W Y T E C'Ty�
NOR LIMIT IN ANY 4
I HERE Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
IS
GIVEN I CORRECT, AND THAT I AM TH. OWNER. OR THE DULY AUTHORIZED AGENT OF
IN. C.NST.UO'
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THE OWNER. I AGREE TO COMPLY WITH CIT IND 5,TATN.AWS `�E.GNWT LOY
THER BY PER LL BE EMP ED
TION. AND IN DOING THE WORK AUTHORIZED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN�S COMPENSATION INSURANCE AND ROW 18.27.
ENT)
E SIGNED
I/L
MARKS
ROGRESS INSPECTIONS PER UBC 11081FINAL INSPECTION REQ'
VALUATION FEE
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL '70
AGINGIFILL
FIEVIEW FEES
INSPECTION FEE
LANDSCAPING
INSPECTION FEE
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
CALL
FOR INSPECTII
(425)
771-0220
ATTENTION L�7 f LA 1 150.3
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-
CATE OF OCCUPANCY HAS BEEN GRANTED, USC SECTION 109 FAX
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T�ISLLPE.R.NNT AUTpH.0LRIlilES ONLY THE W RK NOTED. THIS PERMIT COVERS WORK TO
E SON VAT PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
9RADINGIFILL
-4"MkSURCHARGE
-
.6.00
PERMIT APPL ICATION: 100 DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
I SS THE CITY OF
N INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLE
M EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANYAND
ALLCLAlMS FOR DAMAGES OF WHATEVER,NATURE. ARISING OIRECTLYOR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. SSUANCE OF THIS PERMIT SHALL NOT BE
DEEMEDTOMODWY, WAIVEOR REDUCEANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.
9EVIEW FEES
INSPECT ON FEE
LANDSCAPING
INSPECTION FEE
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
R CLEFT
REL—I
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT I AM THE OWNER. OR THE DULYAUTHOAIZ,EO AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAW EGULAT CONSTRUC
TION, AND IN DOING THE WORK AUTHOFIZ ED TH EREBI. NO F5 ASON WILL 8 E EMPLOYED
IN VIOLATION Or THE LABOR CODE 0 THE STATE OF WASHINGTON RELATING TO
WORKMENS COMPENSATION INSURANCE AND RCW 18.27.
R(�noORAQENT) SIGNED
APPLICATION APPROVAL
CALL S,iIThlpPIllltl -111 - -
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FOR INSPECTION Ilk—ludg.— sp— p—ld-
OFPIALS SIONAT DATE
(425) to
VGNAT
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771-0220
ATTENTION r-A 1 2110 Lo
IT IS UNLAWFUL TO USE OR CCUlY A BUILDING OR STRUCTURE UNTIL 771-0221 1 j " _j�
A FINAL NSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL FILE YEULO� IN'SPECTOR
CATE OFIOCCUPANCY HAS BEEN GRANTED. LIBC SECTION 109 FAX PINK OWNER GOLD ASSESS013
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