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-CONSTRUCTION PERMIT APPLICATION joB
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This Permit covers work to be done on priva(e property ONLY.
Any construction on the public domain (curbs, sidewplks,
driveways, marquees, etc.) will require separate permission.
SURCHARGE
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE
ENG. INSPECTION FEE
"Applicant, on behalf of his or her spouse, heirs, assigns and
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successors in interest, agrees to indemnify, defend and hold
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harmless the City of Edmonds, Washington, its officials,
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employees, and agents from any and all claims for damages of
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whatever nature, arising directly or indirectly from the issuance
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of this permit. Issuance of this permit shall not be deemed to
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modify, waive or reduce any requirement of any city ordinance
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nor limit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
provision."
I hereby acknowledge that I have read this application; that the ATTENTION APPLICATION APPROVAL
information given is correct; and that I am the owner, or the duly
authorized agent of the owner. I agree to comply with city and THIS PERMIT This *application is not.a permit until
state laws regulating construction; and in doing the work authoriz- AUTHORIZES signed by the Building Official or his/her
ed1thereby, no person will be employed in violation of the Labor ONLY THE
- WORK NOTED Deputy; and fees are paid, and receipt is
Code of the State of Washington relating to Workmen's Compensa.
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acknowledged in space provided.
8.27.
An d R OMN INSPECTION
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IG TURE( JOR fGENI.1 DATE SIGNED DEPARTMENT
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OFFICIAL's SIGNATURE DATE
CITY OF
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EDMONDS
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CALL FOR
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T INSPECTION
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
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INSPECTION HAS BEEN MADE AND APPROVAL OR 771m0220 OR NAL — File YELL70— In ector
UNTIL A FINAL
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3. PINK — Owner GOLD — Assessor
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