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Description of Property (Show Below or Attach Four Copies)
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TOTAL AMOUNT DUE
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that
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formation given Is correct: and that I am the owner, or the duly mthor-
Ired agent of the owner. I agree to comply with ally and slate Inmos raga-
ATTENTION
APPROVAL
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ting construction;
AppLICATION
will be employed In Violation at the Labor Code of the Slate of Washington
THIS PERMIT
This application is not a permit until
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relating 10 Workmen's Compensation Imuran-,
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except ]DEMOLITIONS which
ONLY THE
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ahnn be completed In ninety dors: MOVED -IN HOD.DIN08 shalll be was-
WORK NOTED
knowledged in space provided.
plated in sig months.)
INSPECTION
SIGNATURE (OWNER OR AG NT) SIGNED
DEPARTMENT
p RE T 'S BI TU
JDATE
// ti•'
CITY OF
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EDMONDS
DATE
NOTE: Applicant Subject to Plat Check Fee
775-2525
This Permit covers work to he done on private property ONLY.
the domain (curbs, sidewalks, driveways,
ORIGINAL - Fllc YELLOW Inspcuor
Any construction on public
marquees, etc.) will require separate permission.
PINK - Owner COLD - Aseesser
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