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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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S CHARGE
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PERMIT APILICA"..: 11. DAYS
PERMIT LIMIT. I YEAR- PROVIDED WORKS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
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'APPLICANT ON BEHAL OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
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I HEREBY ACKNOW EDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFORMATION
APPLICATION APPROVAL
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INSPECTION 11 � I I -
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHloNGTDN RELATING TO
WORKMEN S COMPENSATION INSURANCE AND RCW 1827.
FOR
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771-0220
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING 08 STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL -FILE - YELLOW- INSPECTOR
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MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
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PERMIT � '7,00&61� _DATEINSPECTED-
DESCRIPTION OF WORK TO BE INSPECTED f Z IOCYA�
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
<Final approval of the described work
___-----Yerformance Bonds associated with the project may be released
GRANT FINAL PROJECT APPROVAL
_GRANT FINAL PROJECT APPROVAL WITH CONDITIONS NOTED
--�FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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RE-INSpECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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1: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC GRAPINOIFILL
2 DOMAIN (CURBS. SIDEWALKS, DRIVE AYS, MARQUEES, ETC.) WILL REQUIRE
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v IGNSANDSUCCESORS
ON BEHALF OF HIS OR HER SPOUSE. HERE. ASS
;APPLICANT.
CITY OF
N INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE NDSCAPING
EDMONDS. WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANYAND INSPECTION FEE
OFINHATEVER NATURE. ARISING DIRECTLYOR INDIRECTLY
A CLAIMS FOR DAMAGES REC EIPT
FLAOM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT 86 PLAN CHECK DEPOSIT
D EMED TO MODIFY. WAIVE OR REDUCE ANY AEOUIREMENT05 ANY CITY ORDINANCE
TO ENFORCE ANY ORDINANCE PROVISION.' RECEIPT
0 NOR LIMIT IN ANYWAY THE CITY'S ABILITY
TOTALAMOUNTOUE
I HERE Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INFORMATION APPLICATION APPROVAL
GIVENS CO RECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
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THE OWNER I AGREE LAWS REGULATING CONSTRUC-
TO COMPLY WITH CITY AND STATE CALL Oull-9011W.— .1 . ut,:..dF .. ... P.4
BE EMPLOYED
TION; AND IN DOING THE WORK AUTHORIZED THERESY� NO PERSON WILL p- ,k—todgad I, w F—ded.
THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
IN VIOLATION OF THE LABOR CODE OF
T
WORKMEN'S COMPENSATION INSURANCE AND ROW 11,11, O��
(425) /� Idl
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J.Ay
17�_
f f 1 -u4r_lj /ELEX-SED BY DATEI
ATTENTION EXT �63
IT IS UNLAWFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221LI
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- OHIGINAL FILE - YELLOW � INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK - OWNER - GOLD - ASSESSOR