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CITY OF EDMONDS
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS. SIDEW ALKS, DRIVEWAYS. MARGUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
to
PERMIT APPLICATION: 180 DAYS
I
PERMIT UMIT� 1 YEAR - PROVIDED WORK S STARTED WITHIN 100 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT ON BEHALF OF HIS OR HER SPOUSE. HEIRS� ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AN.
INDIRECTLY
ALLCI-AIM S FOR DAMAGESOF WHATEVER NATUR E. ARISING DIRECTLY OR
BE
m FROMTHE SUANCEOFTHiSPERM't ISSUANCE OF THIS PERMIT SHAIINOT
IS ORDINANCE
DEEMED To "OD'Fy. WAIVE OR REDUCE AN REOUIREMENT OF ANY CITY
PROVISION.�
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NOR LIMIT IN ANYWAYTHE CITY'S A LITY TO ENFORCE ANY ORDINANCE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AIPLICATION� THAT THE INFORMATION
OR THE DULY AUTHORIZED AGENT 01
GIVEN IS CORRECT AND THATAM THE OWNER,
To COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
THEOVJNER I AGREE
T ION! AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN S COMPENSATION INSURANC E AND RCW 18,27.
SIGNAT��N 0 AG I
DATE SIGNED
VALUATION I FEE
PLAN CHECK FEE
PLUMBING
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STATE SURCHARGE
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ENG, REVIEW FEES
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LANDSCAPING
INSPECTION FEE
RECEIPT
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RECEIPT
TOTALAMOUNT UE
APPLICATION APPROVAL
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CALL
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FOR INSPECTION
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OFFI IALS S11 NATURE
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771-0220
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221 ORIGINAL - FILE YELLOW' INSPECTOR
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- P�NK - OWNER GOLD - ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109 FAX
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OJECT APPROVAL FORM
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DATE:
MEMO TO: P1,17AT R, BUILDING DIVISION
FROM: VIRE DEPARTMENT DATE
______�ENGINEERING DIVISION DATE —
PLANNING DIVISION DATE—
PROJECT—
SITEADDRESS
PERMIT �31 ADB#_DATE INSPECTED ()3
DESCRIPTION OF WORK TO BE INSPECTE
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:
.2final 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
FINAL INSPECTION - OUTSTANDING ISSUES
2.
3.
_RE_INSpECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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ou T C. E
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
LY AUTHORIZED AGENT OF
GIVEN RRECT, AND THAT I AM THE OWNER, OR THE DULY
'NER'
S REGULATING CON STRUC
THE OW LY WITH CITY AND STATE LAWS REGULATING CONS
I AGREE TO CoMp
Y
CALL
CALL
P
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IND ING THE WORK AUTHORIZED THEREBY, NO P2RS I ON WILL BE EM
o To R LATNG To
WASHINGTON RELATING TO
FOR INSPECTII I
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IN VI DILATION OF THE LABOR CODE OF THE STATE OF
WOnKMEN*S COMPENSATION INSURANCE AND RCW 18.27.
T E IIGNE
sIGNAT u
(425)
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M (70 _1
771-0220
EXT 333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL.
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
.771-0221
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
VALUATION I FEE
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�_PPLICATION APPROVAL
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