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PERMIT EXPIRES a
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CITY OF EDMONDS
NUMBER
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. AN CONSTRUCTION ON THE PUBLIC
GRADiNGIFILL
3 RBS,SIDEWALKS. DRIVEINAYSY IEES.ETC.) WILL REQUIRE
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E URCHAHGE
PE MITAPPLICATI N: 180-AYS
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PERMIT LIMID 1 YEAR. PROVIDED WORK IS STARTED WITHIN 180DAYS
STORM DRAINAGE FEES
-APPI-ICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SuCCESORS
ENG. INSPECTION FEE
IN NTEREST. AGREES TO INDEMNI Y. F NO AND HOLD HI I
FIALDSEEEMIPLOYEES,
EDMONDS. WASHINGTON. ITS OFF[ c AND AGENTS 'ROM ANYAND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
BE
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; OM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT
PLA�C.EC-
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MODI
NANYWAYTHECI TY'S ABILITY TO ENFORCE ANYORDINANCE PROVISION,*
NORLIMITol
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE,NFORMAT10N
APPLICATION APPROVAL
IVSN IS CORRECT AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT 01
LAWS REGULATING C.NSlFUC-
CALL
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THE 0 NER I AGREE TO COMP E EMPLOYED
NO PERSON WILL B
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ANDIIN DOING THE WORK ALITHORIZ
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IN OF THE STATE OF WASHINGTON RE ATING TO
IN ECTION
FOR Sp
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VI OLAT ON OF THE LABOR CODE
�ORK.E" COMPENSATION INSURANCE AND RCW 18 21.
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si NIO ERO I D E SIGNED
(425)
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771-022
REL S DAT
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I E OR OCCUPY A BUILDING OR STRUCTURE UNTIL
t_IAW..�
A FINAL HAS BEEN MADE AND APPROVAL OR A CERTIFI�
ORIGINAL FILE YIL'-OW - INSPECTOR
CATE OF OCCUPAN Cy HAS BEEN GRANTED. UBC SECTION 109
PINK OWNER rOLD ASSESS11H
FINAL PROJECT APPROVAL FORM
TO:
-DATE:
M[EMO TO: pERmiT cooRDINATOR, BUILDING DIVISION
FROM: FIR DEPARTMENT DATE
ENGINEERING DIVISION DATE
LANNING DIVISION DAT t,4 oi)
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PROJECT---&f---(—'
SITE ADDRESS —
PERMIT # —ADB#_DATE INSPECTE
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:
_-4—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
I
OUTSTANDING ISSUES
_____—FAILED FINAL INSPECTION
I
2.
3.
_RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
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wall ..........................
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Retaining Wall ...........
Stab Insulation ..........
PLUMBING:
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FINAL APPROVAL FOR
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DOMAIN (CURBS.StDEWALKS, DRIVEWAYS , MARQUEES,ETC.) WILL REQUIRE
SEPARATE PERMISSION.
E U.."R-E
PERMIT APPLICATION: 180 DAYS
IT.,. H`o DAY.
PERMIT LIMIM I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
-To.. DRAINAGE FEE.
STORM DRAINAGE FEES
AN. , ..O.S
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PPLICA- 1111 BEHALF OF HIS:OR HER SF�USE. HEIRS, ASS?rNS'ANI) SUbCESOAS
INTEREST.
END INSPECTION FEE
I E�G. INSPECTION FEE
AR"LESI THE CITY OF
lN� AGREES TO INDEMNIFY DEFEND AND HOLD �ARMLESS THE CITY OF
AGENTS FROM ANY AN.
�m ED'MONDS, WASHINGTON. ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
I� ��2 TL OR '..'.E.TLY
ALLCLAIMSFORDAMA ESOFWHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
G ERMIT SHALL N01 BE
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS P
PLAN CHECK DEPOSIT 41,_ 15 '��J I
D EMED TO MODIFY. WAIVE 08 REDUCEANY REOUIREMENTOF ANY CITY OROINAN'E
C
HEIR LIMIT IN AWWAYTHE CITY'S ABILITY TO ENFORCE ANYORDINANCE PROVISION.*
TOTAL AM
I HEREBY ACKNOWLEDGE THATI HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS COIIIECT* AND THAT I All THE OWNER, OR THE DULY AUTHORIZE" AGENT OF
THE OWNER. DIAGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN 0 NG THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
I
:CALL: Th.. pp"co.— h.t . �y 1�.
&I ... ... p4and
rlNSPECT
IN V, ON OF THE LASOR CODE OF THE STATE OF WASHINGTON RELATING TO
OLAT�
ION 'Ofk
FOR S I .,t,.h�M.wl.d9.d 1� 1 d-
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.21.
11 E SIGNED
( 5 OFFICIALS SIGNATURE
(425)
(0 ER Cet!!
77 _0220
771-0220
AS DATE
TTE T'�N
�,4AVV LT.)U..R..CCU.IYABUILDINGOR STRUCTURE UNTIL
F'NA' � "AS EEN ADE AND APPROVAL OR A GERTIFI
ORIGINAL -FILE - YELLOW - INSIFCT.A
C ATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK - 0 NER - COLD -ASSESSOR