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DATE RECEIVED
CITY OF EDMONDS
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0 NOR LIMIT IN ANYWAY THE CITY'S ABILI rY TO ENFORCE ANY ORDINANCE PROVISIONow
TOTAL AMOUNT DUE
IF CEIPT
IHEREB ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT I AM THC OWNER. OR THE DULY AUTHOEIZED AGENT OF
CONSTRUC,
T1,11 1 . p.1.11 -1.1 .1g- , Ih.
THEOWNER I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING
PE ISON WILL BE EMPLOY ED
CALL
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TION AND IN DOING THE WORK AUTHORIZED T HERE By. NO
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FOR INSPECTION
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NEUR NC
WORKMEN'S COMPENSATION 'JE AND RCW 113.27
OFF�IALS SIGNATURE DATE
______rDATE SIGNED
DAT
(425)
771 -0220
IELEASEDBY
ATTENTION
EXT 333
IT IS UNLAWFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
1
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL, FILE - YELLOW INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER - GOLD - ASSESSOR