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CITY OF EDMONDS
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I HERESY ACKNOWLEDGE TH HAVE READ THIS APPLICATION; THAT THE INFORMATION
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APPLICATION APPROVAL
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TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
WASHINGTON RELATING TO
FOR INSPECTION
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IN VIOLATION OF THE LABOR CODE OF THE STATE OF
WORKMEMS COMPENSATION INSURANCE AND RCW 18,27.
DATE
OFFICIALI;i�
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(425)
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771-0220
RELEASED BY
EXT 333
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771-0221
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FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
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PERMIT APPLICATION; 180 DAYS
PERMIT LIMIT. I YEAR , PROVIDED WORK IS STARTED WITHIN 100 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
SSIGNS AND SUCCESORS
ON BEHALF OF HIS OR HER SPOUSE, HEIRS. A ITY OF
CITY OF
ENO INSPECTION FEE
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EDMONDS, WASHINGTON ITSOF ICIALS, EMPLOYEES. AND AGENTS FROM
ALLCLAIMS FOR DAMArEi3 OF WHATEVER NATURE. ARISING DIRECTLYOR INDIRECTLY
INSPECTION FEE
RECEIPT
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RMIT
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'SABiLITYToENPORCEAWIORD;NANCE PROVISION.'
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NOR LIMIT IN ANY WAY THE CITY
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READ THIS APPLICATION; THAT THE INFORMATION
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IN VIOLATION OF THE LABO CODE OF THE STATE OF WASHINGTON
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TURE DATE
WORKMEN'S COMPEI�SATION INSURANCE ANDRCW 18.27.
OFFICIALS $1
DATE SIGNED
(425)
3/23/w
91
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RELEASED By I
FX '333
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL NSPECTION HAS BEEN MADE AND APPROVAL ORJA CERTIFI-
ORIGINAL FILE - YELLOW - INSPECTOR
CATE OFIOCCUPANCY HAS BEEN GRANTED. UBC SECTION 09
FAX
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