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PERMIT APPLICATION: '80-AYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN IIIII DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
.APPLICANT ON BEHALF 01 HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON, ITS OFFICIALS. EMPLOYEES. AN. AGENTS FROM ANYAND
ALLCLAIMS FOR DAMAGESOF'WHATEVER NATURE, ARISING DIRECTLYOR INDIRECTLY
m FROM THE ISSUANCE OF THIS PZF.I1 ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY. WAIVE On REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION,'
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A FINAL I NSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
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IN INTEREST, AGREES TO NOEMNI "' DEFEND AND HOLD HARMLESS THE CITY OF LANDSCAPING
3 EDMONDS, WASHINGTON, ITS OFFICIALS. MILOYEES. AND AGENTS FRO. ANYAND INSPECTION FEE
ALLCLAIMSFORDAMAGESOFWHATEVER NATURE ARISING DIRECTLY OR INDIRECTL.
= RECEIPT
X FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT,SEALL NOT BE PLAN CHECK DEPOSIT
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT 01 ANY C TYORDINANCE
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TOTAL AMOUNT DUE
1HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION APPLICATION A
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY A THORIZED AGENT OF CALL T" p" .' 1 - pa'�r!!? d 'YL
I L�Y WITH CITY AN D STATE LAWS REU S R C-
THEOWNER, AGREETOCOMP GUILATING CON T U
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IN VIOLATION O'F THE LABOR CODE OF THE STATE OF WASHI NGTON RELATING TO FOR INSPECTION ., -- P.. P1.1d.4.
WORKMEN S COMPENSATI24SURANICE AND RCW 1927, OFF17SM�� f�7 E,
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1 771-02zu RELEASED BY DATE
ATTElfTIOld EXT,1333
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- OFIGINAL-FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK - OWNER GOLD - ASSESSOR
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