20000672.pdfCITY OF EDMONDS
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'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
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IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHI NGTON RE ATING TO
FOR INSPECTION
WORKMEN�=ATION INSURANCE AND RCW 18,27.
DATE7N D
(425)
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771-0220
ATTENTION
EXT 333
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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LID FEE S
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I o N N T E U B L C
BEDONEONPRIVATEPR PERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
T W I.' L E IR
DOMAIN (CURBS, SIDEWALKS, DRIVE AYS, MARQUEES, ETC.) WILL REQUIRE
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ENG, REVIEW FEES
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N E A N SUC." So"S
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ALL CLAIMS FOR D MAGES OF WHATEVER NATURE, ARISING DIRECTLY
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PERMIT SHALL NOT BE
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE Cc THIS PERMIT SHALL NOT BE
sI DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
P A' CHECK DE POSIT
PLAN CHECK DEPOSIT
C F. G
LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
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TOTAL AMOU�T DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
NER I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONST RUC
THE oW . Co S FUC
CALL
L L
'So WILL B M '.YE
TION,�NOIN ONG THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
I
To F L R . TO
LATION OF THE LABOR CODE OF THE'STATE.OF WASHINGTON RELATING TO
IN VO H'�
FOR INSPECTII
WORKMEN S CO=ATI N INSUR NCE AND RCW 16.27.
ED
TE E, N /
(425)
( 5
LV7
1 _0 0
771-0220
ATTENTION
EXT 333
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
FAX
VALUATION I FEE
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