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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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STATE LICEN!,E NUAIBER EXPIR TIONDATE
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REMARKS
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REMARKS
PROGRESS INSPECTIONS PER UBC 108
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FINAL INSPECTION REQUIRED
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PLAN CHECK FEE
BUILDING
HEAT .�OLIRCE
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MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFR.L
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission,
STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: T Year - Provided Work is Started Wlthln 180 Days
STORM DRAINAGE FEE
'Applicant. on behalf of his or her spouse, heirs, assigns and
ENG, INSPECTION FEE
successors in Interest, agrees to indemnify, defend and hold
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. harmless the City of Edmonds, Washington, its officials,
i employees. and agents from any and all claims for damages of
whatever nature, arising directly or indirectly from the issuance
of this permit. Issuance of this permit shall not be deemed toh
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omodify, waive or reduce any requirement of any city ordinance
nor IImd in any way the City's ability to enforce any ordinanceUNT
DUE
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hereby acknowledge that I have read this application; that the
APPLICATION APPROVAL
Information given is correct; and that I am the owner, or the dulyION
authorized agent of the owner. I agree to comply with city andRMIT
state laws regulating construction; and in doing the work authoriz•IZES
This application is not a permit until
ed thereby, n0 person will be employed in violation of the LaborTHE
signed by the Building Official or his/her
Code of the State of Washington relating to Workmen's Compensa•OTED
Deputy; and fees are paid, and receipt is
Non Insurance and RC18.27.
TION
acknowledged in space provided.
SIO r+ RE Ow R O E DATE SIGNED
DEPARTMENT
OF i �S Si NATUPE DATE
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CITY OF
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EDMONDS
CALL FOR
R eE DATE
ATTENTION
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
771-0220
ORIGINAL — File YELLOW — Inspecte
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
SECTION 109
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PINK — Owner GOLD — Assessor
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