20000976.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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4� URCHARGE
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ENG, REVIEW FEES
SEE BAG K OF PINK PERMIT FOR MORE INFORMATION
'A PLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND S CCESORS
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ISUANCE
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END INSPECTION FEE
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EDMONDS, WASHINGTON. ITSOFPICIALS, EMPLOYEES. AND AGENTS FROM ANY AN.
INSPECTION FEE
ALL CLAIMS FOR DAMAGES 01 WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
THIS PERMIT SHALL NOT BE
CHICK DEPOSIT
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THE I OF THIS PERMIT. ISSUANCE OF N1 OF ANY CITY ORDINANCE
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`b DEEMED TOMODIFY. WAIVE OR REIDUCEANY R5QUIREME
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RECEIPT__
OX NOR LIMIT IN ANY WAY THE
TOTAL AMOUNT ..
THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
1 HEREBY ACKNOWLEDGE
GIVEN HE DULY AUTHORIZED AGENT OF
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DATE
WORKMENSCOM N INSURANCE AND RCW 18.21�
OF ICIALSSIGNATURE
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771-0220
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771-0221
NSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI�
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MECHANICAL
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GRPDING)FILL
DOMAIN (CUBES, SIDEWALKS, DRIVEWAYS . MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION,
A� URCHARGE
PERMIT APPLICATION: 181) DAYS
PERMIT LIMIT. I YEAR , PROVIDED WORK IS STARTED WITHIN 18" DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION i
-APPLICANT ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
—
ENG. INSPECTION FEE
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
AND
LANDSCAPING
2 EDMONDS WASHINGTON, ITS OFFICIALS. EMPLOYEES. AND AGENTS F ROM ANY
INSPEC71ON FEE
1. ALLCILAIMS FOR DAMAGES OFWHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
NOT BE
FA M THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL
DEXED TO MODIFY, WAIVE OR REDUCE ANY ReaUIFIEMENT OF ANY CITY ORDINANCE
�LAN CHECK DEPOSIT
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE 'ROVIII—'
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT TH E INFORMATION
AGENT OF
GIVEN IS CORRECT, AND THAT I AM TKCOWNER FATHE 'U�LYAUT"'IZED
TYA 60
ST Te LAW .U�LATING CONSTRUC
CALL
T E OWNER, I AGREE TO COMPLY WIT H
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,ON IN DOING THE WORK AU C TON
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Co F THE STATE OF WASHING RELATING 0
IN VI: OLAT OF THE LABOR DE 0
FOR INSPECTII
WORKMIINSC��$ATION INSURANCE AND RGW 11,2"
DATES71E'
(425)
771-0220
EXT1333
4A*ENTION
USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
77i -0221
IT IS UNLAWFULTO
FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI
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PER UBC 1081FINAL INSPECTION
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