20000023.pdfDATE RECEIVED
FPERMIT EXPIRES
CITY OF EDMONDS
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'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
END. INSPECTION FEE
IN NTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
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INSPECTION FEE
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EDUCEANY REQUIREMENTOFA
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TOTAL AMOUNT DUE
RECEIPT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVEN ISCORRECT.A D THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
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Project Review Checklist
ProjectName:
Plan Check #:
Z��LK3 Receipt Date:
Project Address:
. Underground Wiring Required
F?ECEIVED
Hydraulics Permit
DEC 2 7 1999
plat/Subdivision Requirements
Street Dedications
I'tJBLIC WORKS DEPI
Easements - Public/Private
Engineering Storm Drain Review Feel
5-0 f,
Engineering 2.2 Inspection Fee
Drainage Plan (On -site)
Setback - Storm Drain Line
open Ditch - Existing
culvert Required
Culvert Size
LA- 7-
Shoulder Drainage/Shale Open Runoff
Catch Basin Required
Driveway Slope & Vehicle Access
Sidewalk Required
P e
Curb & Gutter Required
9 e- f 7-
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Curb Cut for Driveway Required
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Street Paving Required
Right -of -Way Construction Permit Required
Bond Required for Public improvements
FEMA Map Check/W ater Table
Side Sewer Availability
Calculate Sewer Fee if No LID#
Water Meter Size
(0�vaternMeteeqruCharge Required
_Ara t R ired
Street Cut
Miscellaneous
5e-r-vt CC (Vrf-
RW Permit Date Issued
Receipt #
SS Permit# Date Issued
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Receipt #
A I Paid $
Date
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MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
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DESCRIPTION OF WORK TO BE INSPECTED hAJaL—
A field inspection was conducted to determine compliance with approved plans. Final approval den . otes that
there are no objections from the above signed Department to the granting of:
___�_—Final approval of the described work
____-----Performance Bonds associated with the project may be released
—GRANT FINAL PROJECT APPROVAL
GRANT FINAL PROJECT APPROVAL WITH CONDITIONS NOTED
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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3.
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SUCCESoRS
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ENG. INSPECTION FEE
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EDMONDS. WASHINGTON
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ALICLAIMSFORD A MAGE� 0TF5WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
.1 THIS PERMIT $HALL NOT BE
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TOTAL A CUNT DUE
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RELATING TO
FOR INSPECTION
FOR
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON
WORKMEN S CO PERSATI INSURANCE AND RCW H.27
DATE
(425)
OFFICIALS SIGXRE DATE
, / co
NT)/ 47
-0220 RELEASED By D L
771
EXT 333
AFENTION L cLcf,
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL. FILE - YELLOW'.;MSPECTGR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK -OWNER - GOLD -ASSESSOR
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