BLD2021-1523_Other_11.9.2021_6.06.47_PM_2512025.,upplcin..ntA,t Sl%Buildin ilamit.com
* Please select who will be performing the construction work on this protect.
12Work to be done by a licensed contractor as listed on this application.
_-Work to be done by the homeowner.
Work to be done by a licensed contractor, not yet selected. Name, State Contractor License Number,
and City Business License Number will tx-- submitted prior to permit Issuance.
*All provisions of laws and ordinances governing this type of work will be compiled with. I certify
under penalty of perjury that the information provided on this application is true and correct and,
further that I am authorized by the owner of the above premises to perform the work for which
the permit application Is made. I further agree to hold harmless the City of Edmonds as to any
claim (including costs, expenses, and attorney's fees Incurred in investigation and defense of such
claim), which may be made by any person, Including the undersigned, and filed against the City
of Edmonds, but only where such claim arises out of the reliance of the City, including its officers
and employees, upon the accuracy of the information supplied to the City as part of this
application.
I hereby authorize the City representatives to inspect my property Monday -Friday between the
hours of 8:00 a.m. and 5:00 p.m. during this permit application process for verifying site
conditions.
I certify, under the penalty of perjury under the laws of the State of Washington, that the
information and exhibits herewith submitted are true and correct to the best of my knowledge
and that I am authorized to file this application on behalf of the owner of the subject property.
s yes
No
*The City of tdmonds makes permit applications available to the public in an effort to make its
processes as transparent as possible. By signing or initialing this document, I acknowledge that
any anc all information submitted as part of this application, is public information. I further
acknowledge and agree that this permit application, and any and all documents related
thereto, may be disclosed by the City of Edmonds to the public without redaction.
Enter your digital signature below.
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