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PERMITEXPIRES
PERMIT
CITY OF EDMONDS
NUMBER
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ENG. REVIEW FEES
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ENFORCE ANY ORDINANCE PROVISION."
RECEIPT
NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO
I I EREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFORMATION
APPLIC ION APPROVAL
GIVEN 15 CORRECT AND THAT I AM THE OWNER OR THE DULY AUTHORIZED AGENT OF
REGULATING CONSTRUC
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FOR INSPECTION
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WORKMENS COMPENSATION INSURANCE AND RCW 16,27.
(4215)
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ATTENTION
EXT 333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE U NTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL FILE YELLOW -INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
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DATE:
NIEMO TO: PERI�UT COORDINATOR, BUILDING DMSION
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___FIRE DEPARTMENT DATE2::��
ENGINEERING DIVISION DATE —
_PLANNING DIVISION DATE
SITE ADDRESS— L?
PERMIT #aa, ____DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED—LLS=1
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:
approval of the described work
Bonds associated with the project may be released
FINAL PROJE CT APPROVAL
__GRANT FINAL PROJECT APPROVAL WITH CONDITIONS NOTED
___FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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2.
3.
___RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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DRIVE WAYS, MAROUEES. ETC.) WILL REQUIRE
2 DOMAIN (CUR . SIDEWALKS,
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SEPARATE PERMISSION.
S PCHARGE
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT: 1 YEAR- PAOVIDEDWORK IS START90 WITHIN 180 DAYS ENG. REVIEW FEES
SEESAC K OF PINK PERMIT FOR MORE INFORMATION
ENG. INSPECTION FEE
'APPUCANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
DEFEND AND HOLD ARMLESS THE CITY OF LANDSCAPING
IN INTEREST, AGREES TO INDEMNIFY.
2 EDMONDS, WASHINGTON. ITS ...... .... NTEFAll E
AULCLMMS FOR DACAGEFEOF WHATEVER NATURE,ARISIN DIRECTLYOR INDIRECTLY
4 NOT BE
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TOTAL AMOUNT US
I HERE Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIOW THAT THE INFORMATION APPLIC ION A P V L
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GIVEN IS CORRECT. AND THAT I AM TH NE., HE DULY AUTHORIZED AGENT OF Th,, ppli, . t , permit ulth lIghld by the
REGULATING CONSTRUC - CALL Fell
THE NER. I AGREE TO COMPLY WITH CITY AND STATE LAWS a,ild,hg Ojeel,l 11 hillhll Deputy: lhd ,, P,Id.
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No PERSON WILL BE EMPLOYED I,
TION;ANDIND ING THE WORK AUTHORIZED THEREBY. IP11.1 ph—dod.
0 RELATING To ipt I, Ilk.owtldgld
CODE OF THE) WASHINGTON FOR INSPECTION
IN VIOLATION OF THE LABOR
ISCT.AlESOF
WORKMEN'S COMPENSATI��RANCE AN 2, OAT
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EXT 333
ATTENTION
IT IS UNLAWFULTO USE OR OCCUPY A BUILDING OR SFRUCTURE UNTIL 771-0221
ORI AL FILE YELLOW INSPECTOR
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- GIN
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK -OWNER GOLD ASSESSOR
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