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1 PERMIT EXPIRES
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F THIS PERMIT AUTHORIZES ONLY TH E WORK NOTED. THIS PERMIT COVERS WORK TO
I BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC GRADINGIFILL
DOMAIN LKS, DRIVEWAY . MAROUEES. ETC.) WILL REQUIRE
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SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT APPLICATION IWIDAYS
PERMIT LIMIT.- I YEAR PROVID D WORK IS STARTED WITHIN VIODAYS ENG, REVIEW FEES
SEE BACK 0; PINK PEEMIT FOR MORE INFORMATION ENG, INSPECTION FEE
W, ;A PLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
INTE EST. AGREES TO INDEMN TY OF
N R "Y DEFEND AND HOLD HARMLESS THE CITY OF LANDSCAPING
IE EDMONDS�WASHINGTON� ITS OFFICIALS, EMPLOYEES, AND AGENTS FRO. ANIANB INSPECTION FEE RECEIPT
ALLCLAIMSFOR AMAGESOF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
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- FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT $HALL NOT BE PLAN CHECK DEPOSIT
0 DEEMED TO MODIFY. WAIVE OR REDUCE ANY REOLAREMENT 01 AN' CITY ORDINANCE
S ABILITY TO ENFORCE ANY ORDINANCE PROVISION," - E RECEIPT
0 NOR LIMIT IN ANY WAY THE CITY E
TOTAL AMOUNT DU
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE IN FORMATION APPLICATION
GIVEN IS CORRECT AND T-T I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF - Tii-11111"I'll 11 1*11 P.
THE 0 NEG I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC CALL T C
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TION, AND IN DOING THE WORKAUTHORZED THE EDYN PERSON WILL BE EMPLOYED
RELATING TO
IN VIOLATION Or THE LABOR CODE OF THE STAT E OPOWASHINGTON FOR INSPECTION
WORKMEN S COMPENSATION INSURANCE AND RCW 18.27 OFFICIALS SIGNATURE
T-NAT DATE IONrO (425)
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771-0220 SELEAn gy
ATTENTION EXT 333
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 G -� YELLOW INSPECT R
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK OWNE GOLD ASSESSOF
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FINAL PROM 21 APPROYAL FORM
TO:
DATE: -
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE-
-1100
ENGINEERING DIVISION DATEA -�
________I?LANNING DIVISION DATE-
PROJECL�Ic"-'�
SITE AD DRESS (,Q r--
p #aC 2- INSPECTED
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DESCRIPTION OF WORK TO BE INSPECTED '4 N(6-tjs v
A field inspection was conducted to determine compliance with approved plans. Final approval denotes that
tbere are no objections from the above signed Department to the granting Of:
_Final approval of the described work
Bonds associated with the project may be released
-GRANT FINAL PROJECT APPROVAL
___GgANT FINAL PROJECT APPROVAL'�qTH CONDITIONS NOTED
_FAILED FIRAL INSPECTION - OUTSTANDING ISSUES
2.
3.
_RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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