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PERMIT EXPIRES
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PLAN CHECK NO: V11TED DATE
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t: BE DONE ON PRIVATE PROPEM ONLY. ANY CONSTRUCTION ON THE PUBLIC
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D OMAIN (CURaS. SIDEWALKS, DRIVEWAYS BE, ETC.) WILL REQUIRE
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RE MITAPPLICATION, 180DAYS
PERMIT LIMIT. I "BAR - PROVI ED WORK IS STARTED WITHIN 180DAYS
Engr.
SEE SACK OF PINK PERMIT FOR MORE INFORMATION
-APPLICANIT ON BEHAL OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS WASHINGTON ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMiI FOR DAMAGZIS OF WHATEVER NATURE, AHIIIN13 DIRECTLY OR INDIRECTLY
Fire Inspection
Receipt #
FROM T.E.SSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT HE
SEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINAN E
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Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION -
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Recording Fee
Receipt #
I HEREBY ACKNOWLE BE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE DIANE � I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application is net, panni—ail signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE 0 WASHINGTON RELATING TO
FOR INSPECTION
Building Offietal 11 halre, Deputy: and Fees am paid, an
acdpl laaakn-ludg.cl In srue. p—ld.d.
WORKMENS COMPENSATION INSURANCE AND RCW 18,27,
DATE
DATE SIGNED
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771-0220
RELEASED 9Y IIATJ
ATTENTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
OR GINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER GOUD.ASSESSOR
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