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PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
Engr. Review
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SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
Plan Chk. Deposit
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HSI�S, ASSIGNS AND SUCCESSORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY 0 F
Fire Review
Receipt #
EDMONDS, WASHINGTONi ITS OFFICIALS, EMPLOYEES, AND AGENTS.FROM ANY AND
Fire Inspection
Total Amt. Due
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
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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 CALL This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- Building Official or hisiher Deputy and Fees are paid. and
FOR INSPECTION
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED -^0 Rd it) space pr o
receipt is wleclo vided
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO (�\ I — .
WORKMEN'S COMPENSA ANCE AND RCW 16:27. ONG DAIr
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SIG 1.111��(VNEF RA T): DATE SIGNED 771-0220
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL - FILE - YELLOW - INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110. PINK -OWNER - GOLD - ASSESSOR
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