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CITY OF EDMONDS
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I HEREBY ACKNOWLEDGE THAT I HAV E READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL i
GIVEN IS CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF P-i-lftp
TIAEOWNER. I AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING CONST CALL ou"T.'" ""N'.
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TION.ANI)IN DING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE IMIL E
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N LAT ON OF THE LABOR CODE OF THE STATE OV WASHINGTON RELATINOYTO FOR INSPECTION
WORKMEN'S COMPENSATION I SURANCEANDIRCW18.27. fllALSfNATURE.6 DATE
S ATU DATE SIGNED (425)
771-0220 RELEASED BY
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ENTION EXT 1333
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IT IS UNLAWFUL TO USE OR OCCUPY A BIJU
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI . .L. - AS N
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK