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U,,DATl RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ER NAMENAME OF BUSINESS
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CITY Zip ITELEPHONE
GOAMAIDS 590ZD
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9�6LAUACHAAGE
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT.- I YEAR - PROVIDED WORK IS STARTED WI HIN 160 DAYS
ENO. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
OFHOqHERPOLSl 1181,AIE�GNEANBSICCEECAS
ON BEHALFC
;APPLICANT.
NDE.N"Y XND .0
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INSPECTION FEE
ALLCLNIMS FOR DAMAGE OrWHATEVER NATURE. ARISING DIFIECTLYOR INDIRECTLY
OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
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PH HIS PERMIT ISSUANCE
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A CEIPT/,5 k
NOR LIMITT IN ANYWAY THE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION AFFKUVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER, 08 THE DULY AUTHORIZED AGENT OF
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THE OWNER. I AGRE To OMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
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771-0220
DATE
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ELEA EDBY
EXT 333
...
ArEN_T_l0W'
... ........ .
IT I� UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-021
FILE - YELLOW -INSPECTOR
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A GERTIFI,
ORIGINAL
A COLD -ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109
FAX
PINK - OWNE