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USE PERMIT
CITY OF EDMONDS
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CONSTRUCTION PERMIT APPLICATION
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PR;0GRESS INSPECTIONS PER UBC 108
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NUMBER NUMBER OF CRITICAL
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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
GRADING/FiLL
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DOMAIN (CURBS.SIDEWALKS, DRIVEWAYS. MARQUEES,ETC.) WILL REQUIRE
STATE SURCHARGE
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I SEPARATE PERMISSION�
PERMIT APPLICATI N: 180 DAYS
PERMIT LIMIt I YEAR - PROVIDED WORK IS STARTED WITHIN 160 DAYS
STORM DRAINAGE FEES
I 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCES6RS
ENG, INSPECTION FEE
IS IN INTEREST AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
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IF EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
A LCLAIMS FOR DAMAGES OF WHATEVER NATURE: ARISING DIRECTLY OR INDIRECTLY
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FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PER -IT SHALL NOT 81
PACHECKDEPO;t�T 00
D EMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY C TY ORDINANC
D E I E
NOR LIMIT IN ANY WAY THE CITY S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.
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TOTAL AMOUNT DUE
! HE FE13Y A.SAOWLEO.E THAT I HAVE SEA. TFII E APPU.�T*N; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHOPUZ5 AGENT Or
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THE OWNER. I AGREE To COMPLY WITH CITY AND STATE L REGULATING CONSTRUC-
CALL T 1�1 11,1111,01" 1, -P
TION� AND IN DOING THE WORK AUTHORIZED THEREBY, NO RE PEON WILL BE EMPLOYED
RELATING TO
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FOR INSPECTION
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON
WORKMEN S COMPENSATION INS�A NCE AND ROW 18,27,
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(425) .,iCtALS SI
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771 -0220
ASE DB DA EF
ATTENT16N`1
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL FILE YELLOW INSPECTOR
A
CATE OF OCCUPANCY)iAS BEEN GRANTED. UBC SECTION 109
PINK OWNER GOLD ASSrSF0R
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