ENG2022-0561+Supplementals_Authorization_and_Acknowledgment_-_Water_Meter+11.15.2022_4.50.45_PM+3221963MyBuildingPermit.com
Jurisdiction: Edmonds
Project Name: Edmonds Lot 2 Residence
Application ID: 1230399
Supplemental Name: Authorization and Acknowledgment - Water Meter
Provide name and address of the party responsible
for paying the Water/Sewer Utility Bill:
Balwant Aulck, 1226 169th PI SW, Lynnwood, WA 98037
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.
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.
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.
Yes, I authorize.
The City of Edmonds 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 and 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.
Please sign below to acknowledge.
Dante Palmaffy