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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
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DOMAIN (CURSS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
15
PERMIT APPLICATION: 180 DAYS
I WIMIT LIMM I YEAR - PROVIDED WORK 15 STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
;AP IN BEHALF OF His OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
N I AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE C17Y OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
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FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITVS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY NTH CRY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AIIIIIHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
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IN VIOL61 OF THE LABOR E OF THE STATE OF WASHINGTON RELATING TO
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OROGRESS INSPECTIONS PER USC 108/FINAL INSPECTION REG`D
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Description
FEE
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FEE
Plan Check
Buildina
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Recording Fee
Engr. Review
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City Surcharge
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State Surcharge
Traffic Mitigation
Plan Chk Deposit
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Fire Review
Receipt #
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Fire Inspection
Total Amount Due
Landscapeinsp.
Receipt #
CALL
FOR INSPECTION
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APPLICATION APPROVAL
This application Is not a permit until signed by the
Building Official or his/her Deputy: and Fees we paid, and
receipt Is acknoyAodged In space provided.
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17 UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
'A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERI 771-02.2111
ORIGINAL -FILE - YELLOW. INSPECAR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK -OWNER - GOLD -ASSESSOR
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