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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
EITY IT111POONE
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NAME
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FPERMIT
EXPIRES
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PERMIT
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RECEIPT
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TOTAL ALOUNIT
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AppLTICEATIO.Y. THAT THE INFORMAVON
APPLICATION APPROVAL
I HERE Y ACKNOWI DGE THAT I HAVE pIEOAWDTHjS
E�8 IS COPPECI A D THAT I AM THE NE . 0, 'LL A ... RIZED AGENT OF
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IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHIONGTON
WORKMEN S COMPENSATION AND RCW 18.27.
OFFIC L IGNA
11 p DATE SIGNED
(425)
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771-0220
R LEA ED Y E
A17ENTION
EXT 333
IT IS UNLAWFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL I NSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE YELLOW . INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
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RECEIVED FINAL PROJECT APPROVAL FORM
APR 6 - 2000 TO:
-DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: IRE DEPARTMENT DATE.
----ENGINEERING DIVISION DATE-4-11
.. ......... . .. .. ............ .
PLANNING DIVISION DATE —
PROJECT
SITE ADDRESS —
PERMIT ----ADB#------DATE INSPECTED —
DESCRIPTION OF WORK TO BE INSPECT
A field inspection was conducted to determine compliance with approved plans. Final approval denotes that
there are no objections from the above signed Department to the granting of:
inal approval of the described work
erformance Bonds associated with the project may be released
_GRANT FINAL PROJECT APPROVAL
—GRANT FINAL PROJECT APPROVAL WITH CONDITIONS NOTED
`1000
FINAL INSPECTION - OUTSTANDING ISSUES
2.
3.
____--RE-INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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,I X&TE RECEtED
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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
DOMAIN (CURBS. SIDEWALKS. DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
STATE SURCHARGE
180.AYS
DAYS
YEPERMITAPPLIC�TION:
PERMIT LIMIT: I All - PROVIDED ORK IS STARTED WITHIN 100
SEE SAC K OF PINK PERMIWT FOR MORE INFORMATION
ENG. REVIEW FEES
ENG. INSPECTION FEE
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
2
EDMONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES. AND AGENTS FRO. ANY AND
ALLCI-AIMSFOR DAMAGES OF WHATEVER NATURE. ARISING DIRE_-- _
PERMIT ALL NOT BE
OF TMS SHORD
INSPECTION FEE
1--1 mW
+ I Wa-0
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE
DEEMEDTO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY Cl TY INANC E
PLAIN CHECK DEPOSIT
0
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROV ISION�'
A EIPT
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION
APPROVAL
GIVEN IS CORRECT. AN. THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
Thil IPPI11111- 11 "1 - P11-11 I �,glld by thl
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTHUC
CALL Build,, Olk,al 11 hislhll D,.ty: ald'Flol 11, P.1d. a�d
TION; AND IN DDING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
THE STATE OF WASHINGTON RE LATING TO
d9ld-p-p-bod.
FOR INSPECTION
IN VIOLATION OF THE LABOR CODE OF
WORKMEN'S COMPENSATO NCBAND R W 113.27.
OIFIC� L NAT, RE ATO
DATE SIGNED
,,,I
(425) t �q)
771-0220 rE
ELEAIED
ATTENTION
EXT 333 V
IT IS UNLAWFULTO USE OR OCCUPY ABUILDING OR STRUCTURE UNTIL
771-0221
HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL FILE YELLOW IN'SPECTOR
A FINAL INSPECTION
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX PINK - OWNER GOLD - ASSESSOR