20000453.pdf7
EXPIRES
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PERMIT
CITY OF EDMONDS
NUMBER
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PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
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STATE SURCHARGE
PE MIT APPlICATI N: 1-0 DAYS
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ENG. REVIEW FEES
SEE SACK OF PINK PERMIT FOR MORE INFDRMATION
;AP LICANT, ON BEHALF OF HIS OR H A SIGNS AND SUCCESORS
P SP'U" ""L.'HARMLE. THE CITY .1
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OF ANY CITY ORDINANCE
ORDINANCE PFOVIEION.�
RECEIPT
OTAL AMOUNT DUE
ACKNOWLEDGE THAT I HAVE RE AD THIS ApCKN� THAT T
APPL IC��ATION PR9VALS
ORTHEIDUL UT.oHEl.l.lORMAlICN
IHERESY
GIVEN I CORRECT. AND THAT I AM THE OWNER, RZ AG ENT OF
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771-0220 RELEA CAT
ExT 333 p
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
FINAL N PECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ICS
ORIGINAL FILE YELLOW INSPECTOR
GOLD -ASSESSOR
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERmrr COORDINATOR, BUILDING DIVISION
FROM: -FIRE DEPARTMENT DATE -
ENGINEERING DIVISION DATE
PLANNING DIVISION DATE-
PROJEC
SITE ADDRESS
ED
PERMIT # 00 6 4'�; -Z> ADB# DATE INSPECT]
9cl q- n 2-
DESCVIPTION 6VWd INSPECTED
A field inspection was conducted to determine final compliance with approved plans. Final approval
denotes that there are no objections from the above signed Department to the release of
PERFOBROCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
u Copy ofCONDfflONS given to owner/contractorby inspector
1.
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contractor by inspector
1.
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign_
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STATE SURCHARGE
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3
PERMIT APPLICATION; 181) DAYS
PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
'SEE BACK OF PINK PERMIT FOR MORE INFORMATION
P LICANT ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
ENG, INSPECTION FEE
;AP
N INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HAR.LES S THE CITY OF
EDMONDS, WASHINGTMITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGE OF WHATEVER NATURE, AR15ING DIRECTLY OR INDIRECTLY
FIR M THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
DGoMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 0 ENFORCE ANY ORDINANCE PROVISION.
NOR LIMIT IN ANY WAY THE CITY'S ABILITY T
TOTAL AMOUNT DUE
IHEFEB ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE IEN.IORMATION
Y
GIVEN IS CO RECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORlil AGENT OF
TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRU%
CAL07e-
THE OW NER. I AGREE
ION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOY'Elo
ATIN.
bl,ki
FOR INSPECTII
IN VIOLATION OF THE tASOR Cook o HE STATE OF WASHINGTON RE
WOAKM�W:�6MPENSATIO INSURA EANDRCW18.27.
R WNER RAGENT) DATE GT
(425)
SIG
771-0220
EXT 333
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A EII)ILDING OR STRUCTURE UNTIL 771'0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
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APPLICATION APPROVAL
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PINK - OWNER GOLD-ASSGSSOR J�