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CITY OF EDMONDS
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IHEREB ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFORMATION
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GIVEN IS CORRECT. AND THAT I AM THE OWNER. OR THE OULY AUTHORIZED AGENT OF
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THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
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WORKMEN S COMPENSATION INSURANCE AND ACW 18,27
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'ATTENTION
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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-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
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PERMIT AF'..-O DAYS
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SEE BACK OF PINK PERMIT FOR MORE INFORMATIONI
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESOAS
ENO INSPECTION FEE
IN INTEREST, AGREES DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
:NDEMNIFY.
EDMONDS, WASHINGTON, TS OFFICIALS� EMPLOYEES, AND AGENTS FROM ANY AND
INSPECTION FE E
ALL CLAIMSFOR DAMAGESOF WHATEVER NATURE�ARlStNODIRECTLYORtNDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
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0 NOM LIM' 1 11 — WAY THE CITY'S ABILITY TO ENFORCE ANY 0 DINANCE PROVISION-�
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT =OAMATION
141,41ot
APPLICATION APPRovAL
GIVEN IS ARECT, AND THAT I AM THE OWNER. OR THE DULY AUTH AGENT OF
CO
TO COMPLY WITH CITY AND STATE
THE OWNER. I AGRE LAWS REGULATING CONSTRUC,
CALL
Th—,o-lonain.l. ,
P'
a, �,Ti
011, t -1 hi�-' D and Foos are paid. and
[ON; AND IN GOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYE"
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING To
FOR INSPECTION
WORKMEN'S COMPENSATION INSURANCE AND RCW 16,27,
OFFICIALSAGN
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ONATU (OWN NT��
(425)
I -11JAIL"
'AELtAS6&tY
ATE
'ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
BEEN MADE AND APPROVAL OR A CERTIFI�
ORIGINAL - FILE YELLOW - INSPECTOR
A FINAL INSPECTION HAS
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX PINK - OWNER GOLD - ASSESSOR