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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ADDRESS
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MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK T.
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE EPUBLIC
ETC.1 WILL R OUIRE
GRA[IINGIFILL
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS , MARQUEES,
PERMISSION.
SEPARATE
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PERMIT APPLICATION: 180 DAY'
YEAR -PROVIDED WORK IS STARTED WITHIN 160DAYS
ENG, REVIEW FEES
PERMITUMIT. 1
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'CANT� ON. "HALFI ASSIGNS AND SUCCESORS
DF HIS OR HER SPOUSE H".Rot
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EN6. INSPECTION FEE
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RECEIPT
TOTAL AMOUNT DUE
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THAITH"NFOR AT'O
THAT I HAVE READ THIS AIPTICEATIUN ME I
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THE OWNER. REE' COMPLY WITH CITY A.6
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TION. AND IN DOING THE WORK AUTHORIZED THERE BY, NO PERSON WILL BE EMPLOY
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FOR INSPECTION
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON
SIONATUR OAT
WORKMEN S COMPENSATION INSURANCE AND PCW 18.27.
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SIGNATUY(OWNER OajV.ENXP'y_ ID-11IGNEU
771-0220
LEASED BY DATE
EXT 333
AtTENTION
IT IS UNLAWFULTOUSEOR OCCUPY ABUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
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SPECIAL INSPECTION
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2-000
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ATE RECEIVED PERMIT EXPIRES
USE PERMIT -W
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CITY OF EDMONDS
'ONE NUMBER
CONSTRUCTION PERMIT APPLICATION
SUITEIAPT*
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OWNER NA�MEMIAME OF BUSINESS
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PLAN CHECK NO: _LSTEO
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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
SIDEWALKS, DRIVEWAY , MARQUEES. ETC.) WILL REQUI RE
DOMAIN (C S
'UNBS'
D SEPARATE PERMISSION.
L
PE RMIT APPLICATION! 180 DAYS
J.YEA R -WITHIN TOD DAYS,� -
R,PROVIDED.WORK.I"TA TED
SEE SACK OF PINK PERMIT FOR MORE INFORMATION
ON BEHALF FHISORHERSPOUSE. HEIRS. ASSIGNS AND SUCCESORS
OF
,w ;APPLICANT.
5 N INTEREST AGREES T �NDEMNIFY, DEPEND AND HOLD H ARMLESS THE CITY
- TSOFFMIALS. EMPLOYEES. AND AGENTS FROM ANYAND
OFW ATEVER�ATURE.ARISiNGC)IRFCTIYO�INDIREC'I
SHALL NOT BE
3 PERMIT
OF ANY CITYORDINANCE
ORDINANCE PROVISION'
I HEREBY ACKNOWLEDGE THAT I HAVE REID THIS IPPLICAlION: THAI THE INIOR�AT ON
GIVEN IS CORRECT, AND THAT I A. THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THE OWNER, I AGREE TO COMPLY WITH CITY AMD STATE LAWS REGULATING CONSTRUC
WILL BE EMPLOYED
TLON, AND IN DOING THE WORK AUTHORIZED THEREBY. N PERSON
III VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING 10
WORKMEN$ COMPENSATIO INSURANCE AND RCW 18,21.
FIA,.lUl�E'(OWNERoa!�aENT) DATE 11G 11
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VALUATION FEE
LAN CHECK FEE
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B ILDING
PLUMBING
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RCHARGE
,AiR*VI5W FEES
ENG. INSPECTION FEE
LANDSCAPING
INSPECTION FEE
PLAN CHECK DEPOSIT
REC 4. 4Z5' 00
TOTAL AMOUNT DUE
APPLICATION APPROVAL
CALL
Bu.1-9 om—I .1 NV1,11 DOP"',
I
FOR INSPECTION ,
OFF C11 SI:TUR DAT
2-
2
(425)
771-0220
R LEASFDBI DATE
ATTENTION — MA 1 -30-2
ITISUNLAWFULTOUSEOR OCCUPYABUILDING OR STRUCTURE UNTIL 771-0221 ONGINAL-FILE YELLOW INSPECTOR
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK - OWNER GOLD - ASSESSOR
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