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CITY OF EDMONDS
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STATE SURCHARGE
PERMIT APPLICATION: VHI DAYS
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RECORD OF INSPECTIONS
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DATE APPROVED
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FOR INSPECTION DATE
WOFIKMEN*S CONPENSATIO.N INSURANCE AND RCW 16.27.
OF C ALS SIGNATURE
(425)
DATE S ONE,
S=E (OWN ER 7 1 z0ag 1 771-0220 EASE By TI
EXT1333
ATTENTION
TO USE OR OCCUPY A BUIL.ING OR STRUCTURE UNTIL
771-0221
IT IS UNLAWFUL
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI. ORIGINAL -FILE - YELLOW - INSPECTOR
A FINAL
OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109
FAX PINK - OWNER - GOLD - ASSESSOR
CATE