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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMUNAME OF BUSINESS
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PERMIT LIMIT.- I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
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ENG. INSPECT10N FEE
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RECEIPT,
RECEIFT_
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE NFORMATION
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AU HORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
TION:ANDiND ING THE WORK AUTHORIZED THEREBY. IN PERSON WILL BE EMPLOYED
IN VIC I a "WASHINGTON RELATING TO
LAT ON OF I HE LABOR CODE OF THE STATE OF
WORKMEN'S AN RCW 18,27.
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771-0220
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HAS BEEN MADE AND APPROVAL OR A CERTIFI-
EXT 333
771-0221
ORIGINAL - FILE YELLOW - INSPECTOR
A FINAL INSPECTION
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STATE SURCHARGE
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PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENO. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-APPLICANT. ON BEHALF OF S 0" HER Sp .. E 'E' UAS' ME U E IS
END. INSPECTION FEE
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TOTAL AMOUNT DUE
I HERE Y ACKNOWLEDGE THAT I HAVE HEAD THIS APPUIC ON; THAT THE INFORMATION
5 ATI
PLICATION AP ROVAL'
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GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
0 MPLYWITHCIT AND STATE LAWS REGULATING CONSTRUC-
I AGREE T Co Y
CALL PF': I. t." F"_ t U.1i od by Ihl
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TION; AND IN DOING THE ORKAU EDTHEREOVNOPERS NWILLBEEMPLOYED
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SOR COTHORIZTH E
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WORKMEN'S COMPENSATI_qh*SKA NCE AND HOW 18.27.
y FICI LS SIGNATURE DATE
-tUFIE IOWNE�pb GAT E SIGNED
(425)
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771-0220 F �IEASEO By
-WE ON
EXT 333
A
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 YELLOW- INSPECTOR
SECTION 109 FAX PINK - OWNER GOLD - ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC
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