BLD2022-0488_Supplementals_4.18.2022_3.06.04_PM_2809619. OF tp,b
v OHO
MyBuildingPermit.com
Jurisdiction: Edmonds
Project Name: LUCAS 019969
Application ID: 1126393
Supplemental Name: Authorization Statement - Mechanical
All provisions of laws and ordinances governing this type of work will be complied 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.
Yes