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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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I H EREBY ACKNOWLEDGE THAT I HAV 2 READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAL
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ENG. INSPECTION FEE
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N NTGREST. AGREES TO INDEMNIFY.
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INSPECTION FEE
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PLAN CHECK DEPOSIT
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REIEIPT
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TOTAL AMOUNT DUE
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IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INFORMATION
APPLICATION
APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORI ED AGENT OF
T,I ". 1 . P.-I umil "g-O by-
THEOWNER IAGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
WILL BE EMPLOYED
CALL I .,I FD � 1.1 r hWh.r D-I, .�d F .1. P.4
TION, AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSCN
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION ra p� I. wl.dl d sp-o provldld.
WORKMEN'S COMPENSATION INSURANCE AND RCW 16.27.
OF IGNATURE ATE
1 DATE SIGVED
(425)
SIGNATURE OWNER 0
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771-022 0
QL
_1 R L BEY DATE
ATTENTION
EXT 333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL -FILE - YEULOW- INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTiON 109
FAX PINK - OWNER - GOLD - ASSESSOR