20000393.pdfPERMIT EXPIRES
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PERMIT 200393
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SEPARATE PERWISSION.
PER MIT APPLICATION: 180 DAYS
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFORMATION
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AND STATE LAWS REGULATING CONSTRucl
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WORKMEN S COMPENSATION INSURANCE ANDRCW 18 27,
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ORIGINAL FILE - YELI.W INSPECT .11
OFIOCCUPANCY HAS BEEN GRANTED, UBG SECTION 109
PINK OWNER - GOLD -ASSESS..
CATE
Project Review Checklist
Project Name:
Plan Check#:
Receipt Date: 1�c
Project Address:
RECEIVED
Underground Wiring Required
MAY 0 4
Hydraulics Permit
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P lat/Subdivision Requirements
PUBLIC WORKS OEPI
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Bond Required for P ublic Improvements
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RWPennit# Date issued
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MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIR DEPARTMENT DATE
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PLANNING DIVISION DATE
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DESCRIPTION OF WORK TO BE RMNSPECT Ka
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:
Final approval of the described work
�Perfo ance Bonds associated with the project may be released
--X�GRANT FINAL PROJECT APPROVAL
_GRANT FINAL PROJECT APPROVAL WITH CONDITIONS NOTED
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AILED FINAL INSPECTION - OUTSTANDING ISSUES
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_RE-INspECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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USE
PERMIT 200:393
CiTY OF EDMONDS ZOE
NUMBER
PERMIT APPLICATION JOB
SUITE/APT-
CONSTRUCTION
—NAMENAME
AODR`t� 2,cl
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OWNER OF BUSINESS
DESCRIPTION CHECK
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PROPOSED
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NO. OF FIXTURES PRV REQUIRED
YES.y NO C3
AWRESS
REMARKS'
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CITY PHONE
NAME
ENGINEERING MEMO DATED
REVIEWED BY
ADDRESS
FIRE MEMO DATED
WEDBY
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SHORELINE #
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VARIANC ORCU
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VATS PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS,SIDEWALKS. DRIVE WAYS. MARQUEES,ETC.) WILL REQUIRE
�RADINGIFILL
L SEPARATE PERMISSION.
STATE SdA`CMAA.E
PERMIT APPLICATION: ISO DAYS
FEES
A, PERMIT LIMIT. I YEAR - PROVIDED WORK 15 STARTED WITHIN 180 DAYS
STORM DRAINAGE
A
ON BEHALF OF MIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESO S
EN - NSPECTION FEE
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EDMONDS. WASHING M S.AN
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DIRECTLYOR INDIRECTLY
ALLCLAIMSFOR DAMAGESOFWHATEVER NATURE� ARISING
'ROM TH"`SANCE OF TH' PERMIT. ISSUANCE OF THIS PERMIT SMALL NOT BE
PLAN CH CK DEPOSIT
0 0
Y
DE,.EDTO,,OIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CIT ORDINANCE
0
NOR LIMIT IN ANYWAY THE CITI-SABILITY TO ENFORCE ANYORDINANCE PROVISION.-
TOTAI AMOUNT DUE
Y ACKNOWLEDGE THAT �HAVE .�AWDT.,,.. AppHC.ATI�OLN� T1.1AT THE INFORMATION
APPLICATION PPROVAL
IHERE
GIVENS RECTANDTHATIA THE 0 HE . OFT . A THORtZED AGENT OF
IS Co
'I REGULATING CONSTRUC
T�.Ppaii I.,. a pa-1 onfil .,gn.d sy In -
AGREE TO COMPLY WITH CITY AN
THE OWNER. D STATE LAWS
PERSON WILL BE EMPLOYED
CALL
'josol,
8,JIdi , opuly: and Foss— paid. and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO
Or WASHINGTON RELATING TO
FOR INSPECTION
9,0111-1
aon,pl,, ..k.s.I.dq.d in vuo pwldod.
IN VIOLATION OF THE LABOR CODE OF THE STATE
ORKMENOS RENSATION INSURANCE AND RCW 16.27.
W Won Com
ADEN T D ATE SIGNED
(425)
FFICI GNAT
�IoNATURE JOWNER OR
771-CI220
DATE
REL Y 2
ATTENTION
TO USI E OR OCCUPY A BUILDING OR STRUCTURE UNTIL
_�RIGINAL HISPEII-R
IT IS UNLAWFUL
HAS BEEN MADE AND APPROVAL OR A CERTIFI,
- FILE YEL. -
OOLD-ASBES�OR
A FINAL INSPECTION
HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNM
CATE OF OCCUPANCY