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CITY OF EDMONDS
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Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERV ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
W PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Fire Review Plan ChIk. Deposit
eAPPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANYAND Fire Inspection Receipt #
ECTLY OR INDIRECTLY
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIR
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE Landsc
MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE ape Insp. Total Amt. Due
DEEMED TO
ILITY TO ENFORCE ANY ORDINANCE PROVISION.' Receipt 0
0 NOR LIMIT IN ANY WAY THE CITYS AB Recording Fee
I HEREBY ACKNOWLEDGE 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 This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building 011icial or his/her Deputy: and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED FOR INSPECTION receipt Is acknowledged In space provided.
IN VIOLATION OF THE LABOR CODE OF THE STATE Oy WASHINGTON RELATING TO ATE
WORKMEN'S COMPENSATION OFF1 S URE
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S 12G M (OWNE DATE SIGNED (425) h
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IT IS UNLAW50 TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL IN9PECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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