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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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REMARKS
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
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STATE SURCHARGE
4+,S-0
P MITAPPLICATIoN: 180DAYS
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PERMIT LIMIT. 1 YEAR ' PROVIDED WORK S STARTED WITHIN 180 DAYS
SSE BACK OF PINK PERMIT FOR MORE INFORMATION
ENG. REVIEW FEES
;A PLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
P BE S T NO
1� N INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
E MONDE. WASHINGTON, ITSOFFICIALS EMPLOYEES. AND AGENTS FR A YAND
'N Mo BE WAE.'NGT. 'T o FC'A E. oy ESS OM N
ALLCLAIMS FOR DAMAGEiOF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
D LC 'ME . M G OF W T VER NATURE - ARI
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT E
E
DEEMEDTO MODIFY,WAIVEOR REDUCE ANY REOUIREMENTOF ANYCITY ORDINANCE
W Y T 'S ABILITY TO ENFORCE ANY ORDINANCE PROVISIONI.�
0 R .IT , Y CITY.
NOR LIMIT IN ANYWAY THE CITY
ENG. INSPECTION FEE
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PLAN CIA CK DEPOSIT
AMOUNT DUE
RECEI
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT I A. THE OWNER. OR THE DULY AUTHORIZED AGENT OF .
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
TION. AND IN DOING THE WORK AUTHORIZED THEREBY� NO PERSON WILL BE EMPLOYED
THE STATE
IN VIOLATION OF THE LA60R OF WASHINGTON RELATING TO
�ORKMEWSCOM�TION UFANC NO RCW 1827
Sr �E i� A� T AlE SIGNED
APPLICATION APPROVAL
Th_,pp,.,.I., 1 , Pjj .1 4,pld by -
CALL oll,-I 1,�ftl D-ty: -d F- ... ...
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FOR INSPECTION ' P'
OF �LESIGN'AT..Eo CATE
(425) Aten, Lit' H4,
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771-0220
ILEASED BY
6�L ';;�
ATTENTION L
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTI
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR AgCERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 10
EXT/333
771-0221
FAX
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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MISCELLANEOUS ..........
FINAL APPROVAL FOR -a 4
OCCUPANCY ..................
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CITY OF EDMONDS NUMBER
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OVINERICONTRACTOR RESPONS18LE FOR EROSION CONTROLIDRAINAGE
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CA,
A
VALUATION
FEE
PLAN CHECK FEE
HEAT GLAZING % LOT SLOPE %
BUILDING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE
GRADINGfFILL
EPUBLIC
DOMAIN (CURBS, SIDEWALKS. DRIVEWAY , MARQUEES. ETC.) WILL R QUIRE
:3 SEPARATE PEZISSION.
I-
STATE SURCHARGE
2 PERMIT APPLICATION: Ill. DAYS
PERMIT LIMIT, I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
a
E MG. INSPECTION FEE
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HIMS, ASSIGNS AND SUIIESO Rs
,
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY Or
EMPLOYEES. AND AGENTS FROM ANY AND
..... k
EDMONDS� WASHINGTON. ITS OFFICIALS.
ALL CLAIMS FOR DAMAGES OFWHATEVER NATURE. ARISING DIRECTLY DR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT
DEEMED TO MODIFY, WAIVE OR REDUCE ANY R UIREMEWt�,TOFAN ORDI NAN
PLAN CHECK DEPOSIT
0 M TO &Q NY�ITY
DR LIMIT IN ANY WAY THE CITY'S ABILITY FPR CE PHu-i -
.
TQfA,L AlMOP,yT DUE
I HE RE8,Y ACKNOWLEDGE THAT: HAVE READ THI S APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN $CORRECT. AND THAT AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
Thil 1pPllK �,j , pormit ultil lipld by th,
T EOWNEFI. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
CALL
SU'l dlq Olfi.l.:,.. I,I.ftr D F .1. P.1d. ..d
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
STATE OF WASHINGTON RELATING TO
FOR INSPECTION
�p. .d
dly:.
..ipl k,-I.d: 1� o p-ld.d.
I N VIOLATION OF THE LABOF�$=AeNOF THE
WORKMEN'S C(?�Ie5NpTIoN UR CB.AND RCW 18.27.
OF I IALS SIGNATURE DATE
_sltm GAT SIGNED
(425)
S (t�L �NT
771-0220
ELEASED By
ATTENTION
EXT/333
IT IS UNLAWFUL TO USE OR OCCUPY A PUILDING OR STRUCTURE UNTIL 771-0221
HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORtrINAL-FILE YELLOW -INSPECTOR
A FINAL INSPECTION
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER GOLD - ASSESSOR
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