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SEE BACK OF PINK PERMIT FOR .. E "I'D
0 ;APPLICANT ON BEHALF OF Ht - S OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS INSPECTION FEE
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cl DEEMEDTOMODIFY, WAIVEOA REDUCE ANY RCOUIREMENT OF ANY CITY ORDINANCE
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TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT � AHAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT M THE OWNER, OR THE DULY AUTHORIZED AGENT OF Thi. appI,on,, w , p,j 11il 11011d by 1h,
T E EA . I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC� CALL
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'K INSPECTION 0,11, llkbdgld,� SpIle p—ld.d.
N V16LATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR DATE
WORKMEN'S COMPENSAT'lON IN�URANCE AND POW 18.27� FFICIALS IS TUBE
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ATTENTION EXT/333
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- ORIGINAL - FILE - YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK - OWNER - COLD - ASSESSOR
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SIDEWALKS, DRIVEWAYS, MARQUEES.
3 SEPARATE PERMISSION,
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a PE MiTAPPLICATION ISODAYS
1. PERMITLIMIT:11 YEAR" PROVIDED WORK IS STARTED WITHIN 16004YS
SEE SACK 0, PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF 1111 OR HER lP011E* 8111S, ASSIGNS AND SUCC11ORS
IN INTEREST, AGREES TO INDEMNIFY DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
ALLCLAIMS FOR DAMAGESOFWHATEVER NATURE, ARISING D,,s,,,,
S
FROM THE I SUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
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0 TIN ANY WAYTHE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION,
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GIV5NIS CORRECT. AND THAT I AM TH OWNER, OR THE DULY AUTHORIZED AGENT OF
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WORKMENS COMPENSATION INSURANCE AND RCW 18.27.
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U. DA,
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:ZFCIALISIG T S DATE
C7URE(OW— AZE64'
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771-0220
RhLEASEDBY -7
ATTENTION
EXT1333
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-
OSIGINAL-FILE YELLOW -INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER - GOLD - ASSESSOR