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PERMIT
PERMIT
CITY OF EDMONDS ME NUMBER Q,00156
CONSTRUCTION PERMIT APPLICATION JADDRESS
OWNER NAME/,NAME OF BIUSINESS
PLAT NAME)SUBDIVIStON NO. LOT 00, LID NO.
11D FEE
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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
GRADINGIFILL
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
URCHARGE
PERMITAPPLICATI N: 180DAYS
PERMIT LIMIT 1 YEAR. P ROVIDED WORK IS STARTED WITHIN 1 8D DAYS
ENG� REVIEW FEES
SEE SACK OF PINK PERMIT FOR MORE INFORM ION
ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
ENG, INSPECTION FEE
�APPLICANT.
N INTEREST, AGREES TO INDEMNIF Y, DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAP NO
EDMONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES. AND AGENTS Fn OM ANY AND
INSPECTION FEE
A LCLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY 0 - INDIRECTLY
'L S PE SS ANCE OF THIS PERMIT SHALL NOT Be
I R M THE ISSUANCE OF THI AMIT U
PLAN CHECK DEPOSIT
DEOEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
PROVISION
0 NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANYORDINANCE
TOTAL AMOUNT DU
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I HEREBY ACKNOWLEDGE THAT : HAVE READ THIS APPLICATION. THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
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THE OWNER. I AGREE TO C PLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
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IN VIOLATION OF THE LABOR CO DE OF THE STATE
WORKMEWS COMPENSATION INSURANCE AND RCW 19.27,
OFFICIA ff
TS tGNED
(425)NT)
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771-0220 RELEASED By I IIIE
EXT 333
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ATTENTION
To USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
IT IS UNLAWFUL
AND APPROVAL OR A CERTIFI-
ORIGINAL -FILE - YELLOW -INSPECTOR
A FINAL INSPECTION HAS BEEN MADE
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
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