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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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RECEIPT
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]HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THU OWNER, OR THE DULY AUTHORIZED AGSNT OF
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION JOB SUJTEJAPTF
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SEPARATE PERMISSION.
STATE SURCHARGE
YE PERMIT APPLICATIO N 180DAYS
PERMITUMIT1 AR. PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
CITY OF
ENO. INSPECTION FEE _50
;A ,LT..A�N�Ti,'�'..E"�'.LFT. INDEMNI DEFEND AND HOLD HAR SS THE
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RECEIPT
NOR LIMIT IN ANY WAYTHE CITY'S ABILITY
TOTAL AMOUNT DUE
I HEREBY HAIITE�RIAO THIS APPLICATION; THAT IRE INFORMATION
APPLICATION APPROVAL
=T��D�GIETTHI�T �
GIVE ",YAER RATT"EDUSLy"AUTHOTIllIDAIE.T.1
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THE OWNER, I AGREE TO COMPLY WITH
TION, AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
RELATING TO
Bildilgo(teialo"'
FOR INSPECTION eckn.wle�ged,,, e, -,-
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON
1817,
E n
WORKMEN .1 COMPENSATION INSURANCE AND HOW
O�Rcij SIGN
(425)
St NATURE (0 E"` 0 T)
757,
at)
771-0220 RELEAS B DAT
ATT , ENtION
EX T 333
IT IS UNLAWFULTO USE OR OCCUPY ASUILDING OR STRUCTURE UNTIL
771-0221 INSPECTOR
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
�j ORIGINAI FILE - YELLOW.
- GOLD -ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109
PINK-OWMER
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