20001009.pdfDATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE P
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OMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
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a SEPARATE PERMISSION.
E 'ERMITAPPLICATIoN: 180CAYS
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PERMIT LIMIT: I YEAR PROVIDED W RK IS STARTED WITHIN Ist) DAYS
T ' YEAR -
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORM kTtON
E BACK OF
ON BEHALF OF� HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
;APPLICANT
INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
EN
-ON.S. —ASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
INSPECTION FEE
< ALL CI-AIMSFORDAMAGESOF ATEVER NATURE, ARISING DIRECTLYOR INDIRECTLY
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FA m rHE ISSUANCE OF THIS PER SUANCE OF THIS PERMIT $HALL NOT BE
MIT, IS
DEEMED TO MODIFY, IVE OR REDUCE AN R QUIREMENTOF ANY CITY ORDINAN E
W
PLAN CHECK DEPOSIT
0 NOR LIN11T IN ANY WAYTHE CITY'$ ABILITY TO ENFORCE ANY ORDINANCE PROVISION'
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=====LZOTAL
AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
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THE OWNER, I AGREE TO CO PLY WITH CITY AND STATE LAWS REGULATING CONSTRUC,
CALL
TION, AND IN -ING THE WORK AU HORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION - THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTII
WORKMEN'S CO.PENSATION INSURANCE AND RCW 113,27,
SIGN7 (OWNER 0 E DATE SIGNED
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771-0220
ATtENTION
EXT/333
IT IS UNLAWFUL TO USE 013 OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CEFTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
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- APPLICATION APPROVAL
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