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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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VESTED DATE
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THIS PERMITAUTHORINS ONLY THE WO KNOTED.THIS PERMIT COVERS WORK TO
t: BE INS I" P111 P101BITTY O.L'(. A. C0.STRUCm.. ON THE PUBLIC
Grading
Recording Fee
DOMAIN JCUASS, SIDEWALKS, DRIVEWAYS, MARQUEES, UC.) WILL REOUINE
SEPARATEPEFIMISSION.
PER ITAPPLICATION: 180DAYS
Engr. Review
City Surcharge
PERMITUMMIYEAR PROVID 0 WORK IS STARTED WITHIN 111.DAYS
Engr. Inspection
State Surcharge
SEESACKO;PiNK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF His OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Traffic Mitigation
Plan CRIS Deposit
IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARML SS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
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Fire Review
Receipt #
ALL CLAMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE I SUANCE OF THIS PERMIT ISSUANCE F THIS PERMIT SHALL NOT BE
Fire Inspection
Total Amount Due
DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0. NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
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I HERE ACKNOWLEDGE THAT I HAVE REM THIS APPLICATION: THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
THE OWNER. I AGRE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application is not a Pariah until Signed by ffie
TION, AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND FICW 18,27.
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FOR INSPECTI N
Building Official ., hi,ih.1 Deputy: and Fees .. Paid, and
receipt is ack—ledged In space Pna,,ded.
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DATE SIGNED
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RELEASED B DATE'
ATTENTION
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CIERTIFI-
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ORIGINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109
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FINAL APPROVAL FOR
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