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RECEIPT
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 01
THEOWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
TOTAL AMOUNT DUE
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—
PPLICATION APPROVAL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
1 N VIOLATION OF THE LABOR CODE OF THE
CALL
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STATE OF WASHINGTON RELATING TO
WORKMENS COMPENSATION INSURANCE AND RCIW 18.27,
FOR INSPECTION
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SIGNATUR
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ATTENTION
DATE
IT IS
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UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
771-0221
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION log
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RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMFJNAms OF BUSINESS
MAILING ADDRESS
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P MIT APPLICATION: 180 DAYS
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OTAL AMOUNT DUE
RECEIPT
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IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION
APPROVAL
GIVEN I RECTANDTHATI AMTHEOWNER,ORTHE DULY AUTHORIZED AGENT OF
S DO R
Thil ppjj,,Jj0n I, p-11 Iltil lIgned by In,
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THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING NSTRUC-
CALL
BuildIng Ojj,�W �l in,,1n., DIy: nd F... .1. P.1d..nd
TION: AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
OF WASHINGTON RELATING TO
FOR INSPECTION
r—iPI 1. ...I.dg.d in .. Fid.,i.
IN VIOLATION OF THE LABOR CODE OF THE STATE
Ki COMPENSATION INSURANCE AND RCV/ 18.27.
OFFICIA SIGN 16E T
SIGNED
(425)
/D
2��RAGINTI
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1
1 f 1 "Li
RifLEASED BY DATE
ATTENTION '6CTURE
EXT13,33,
IT IS UNLAWFULTO USE OR OCCUPY A BUILDING OR STR UNTIL
HAS BEEN MADE AND APPROVAL OR A CERTIFI-
771-0221
I
ORIGINAL FILE YELLOW :INSPECTOR
A FINAL INSPECTION
CATE OF OCCUPANCY HAS BEEN GRANTED.'UBC SECTION 109
FAX
PINK - OWNER GOLD - ASSESSOR