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PE MITAPPLICATION: ISODAYS
PERUITILIMITIVEAR-PAOIA go WORK IS STARTED WITHIN I80OAYS
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See SACK OF PINK PERMIT FOR MORE INFORMATION
Engr, Inspection
State Surcharge _J15z
Traffic Mitigation
Plan Chk Deposit
ON BEMAII OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTE AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
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Receipt III 2,95-M
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EDMONDS, WAII INGTON, ITS OFFICIALS, EMPLOYEES, AND ADEN' I FROM ANY AND
ALL CLAIMS FOR =AGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
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FR M THE ISSUANCE OF MIS PERMIT. ISSUANCE OF , PERMIT SHALL NOT
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Total Amount Due
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Receipt #
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I HEREBY ACKNOWLE BE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
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GIVEN IS CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
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THE OWNS � I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
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IN VIOLATION OF THE LABO CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
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WOMMEN'S COMPENSATION INSURANCE AND FICIN 18,27.
LJAL� IONA E DATE
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ATTENTION
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
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