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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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ENG. INSPECTION FEE
PPLICANT. ON BEHALF o R SIGNS AND SUCCESORS
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N E E AD E , I ' EMN"Y. DEFEND AND HOLD HARMLESS THE CITY OF
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EDMONDS. WASHINGTON ITS OFFICIALS. EMPLOYEES� AND AGENTS 'ROM ANYAND
ALLCILAIMS-FOR DAMAGESOI WHATEVER NATURE.ARISING DIRECTLYORINDIREcTLY
!NSPECTION FEE
RECEIPT
I FROM THE ISSUANCE OF THIS PER.'T I SSUANCE OF THIS PERNIT SHALL NOT BE
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DEEMED TO MODIFY. WAIVE OR REDUCE ANY E I REMENT OF ANY CITY ORDINANCE
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R LIMIT IN ANY WAY THE
0 NOR LIMIT
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TOTAL AMOUNT DUE
JR7CEIPTJ I 9,F
I HEREBY ACKNOWLEDGE THAT: HAVE READ S APPLICATION. THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT A THE OWNER. OR THE DULY AUTHORIZED AGENT 01
CO�5TAUC
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THEOWNER IAGREE Toe WIT. CITY AND STATE LAWS REGULATING
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CALL
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O.K AUTHORIZED
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FOR INSPECTION
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IN VIOLATION
WORKMEN S COMPENSATION INSUR�YCE AND RCW IB.27
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FFI IS SIGNATURE DATE
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771-0220
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. ATTENTION
EXT 1333
IT IS UNLAWFUL TO USE 08 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
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COMPLETE I EIE PT
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MECHANICAL
THIS PERMIT AUTHORIZES O"LYTHE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTAU CTION ON THE PUBLIC
GRADINGiFILL
*3 DOMAIN ICURBS. SIDEWALKS. DRIVEWAYS MARQUEES, ETC.) WILL REQUIRE
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SEE BACK OF PINK PERMIT FOR NOSE INFO
ON BEHALF OF HIS 09 HER SPOUSE. HEIR S, ASSIGNS ANO%*ft4VSh
END. INSPECTION FEE
;APPLICANT,
N INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMOES5 I m 6111 11
AND AGENTS FROM 6NY AND
LANDSCAPING
FEE
I EDMONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES,
A CLAIMS FOR DAMAGES OFWHATEVER NATURE. ARISING OIH.0
INSPECTION
FLRLOM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PEF�J�I�N L T
0 E.E.T. 'GPy..AIVE.. REDUCE ANY FE.UHIENE.T.F ANY CITY ORDINANCE
LAN C, ECK DEPOSIT
NOR LIMIT IN ANYWAY THE Cil-Y-S ABILITY TO ENFORCE ANYOROINAICE PROVISION.-
TOTAL AMOUNT DUE
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHOR! ED AGENT OF
THE OWNER' IAGREETO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC -
CALL
TION, AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTIC
IN VIOLATION OF THE LABOR
WORKM5U��SATION WSUPPJCEAND RCW 18.27.
I DATE SIGNFO
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L7U O�
771-0220
EXT 1333
ATTENTION
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,
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
Sao
DATE
OR ADSN "B""TH
RED . EXISTED
NO
HEIGHT
ALLOWED , PROPOSED
IFT, PROPOSEDSETRACKS(FT.)
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