20000773.pdfDATE RECEIVED [PERMIT EXPIRES M�2
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
IER NAMrjNAMZ OF SUSINSFn
... PERMIT �Q,0,0773
ZONE 66 NUMBER
JOB TSIAPTI
ADDRESS 2 /&ao 1-11exwo'l
PLAT NAMEISUBDIVISION NO. LOT NO.
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REMARKS
WNE..lTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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PLAN CHECK 11U.' VESTED DATE PLUMBING 60
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC GRADINGIFILL
SEPARATE PERWIMA QUIES, ETC.) WILL REQUIRE
' 2 DOMAIN (CURDS, SIDEWALKS, DRIVEWAYS ESIR
.1 ON,
STATE SURCHARGE
PERMIT APPLtCATIONh 180DAYS
PERMIT LIMIT.- 1 YEAR � PROVIDED WORK IS STARTED WITHIN 180 DAYS ENS, REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
�APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS ENG.. CTIONFEE
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY F N
EDMONDS, WASHINGTONL ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND It
L CL,, M�S'F.O R DNA.M.AGEFSTO"F, �WPAT El., NAT U BE, AR I B I NO DI R ECTLY . R I NO, R F-Tl RED T
PERM T SHALL NOT BE
F I.. T. UA RMIT S SUANCE OF THIS IT PLAN ECKD�POSIT /lot,
DEEMED TO MODIFY, WAIVE R REDUCE ANY REQUIREMENT F ANY CITY ORDINANCE
0 Y'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION,' IPT
NOR LIMIT IN ANY WAY THE CIT TOTA AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE IN FORMATION APPLICATION APPROVAL
GIVEN S CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF Thl, not a nnit ntil ,good by The
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL lh,ild,ng Olki.l ., llt,lhm� D
TtON; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED FOR INSPECTIO gouty; no F .1. P..b.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RE LATING TO N I, ,know I 91d �l poll pl-d1d.
WORKM5N'S COMP SURANCE AND RCW 18.27. OF I GNA DATE
GNA NER 0 ID ED (425)
771-0220 ASED By
AtTENTON EXT1333 �7
IT IS UNLAWFUL TO USE 08 OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221 - .141� <714
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL FILE - YELLOW - INSACTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109 FAX PINK - OWNER - GOLD - ASSESSOR
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��IP;u.DEPARTMENT OF SUILDINGd'�-q�,;.
I'.. .,LDNG CODE SECTION 1"
At, Bulldlng,j!j�r
Goo HicahwArit $9, #205
-NIA** No. Stories: 3
Occupancy established by this ceroicate: Dwelling Units:
C
B TyptConstr Vi -Hr. 4nk Basement: NIA
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indmum J.4.psht L..d'
M J.B.C. 1002)
Roo� capsaft posted sit es.
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y S19140, "It"Jim
Owner of Building: Kruger Clinic
r'PLYI1G WITH THE REQUIREMENTS OF THE
THE CY AND THE USE
D, DIVISION OF OCCUPAN
KaUl .... "M
'997 EDITION OFTHE UNIF W 02MINt 00 1 01 D. I P N
FOR WHICH THE PROPOSED OCCUPANCY IS C
-er
Issued this 2000
C P, L
BY:
Thl. badnbaa he" beaded in . pb#... andithaRnOtba—.0,inuill ted—bacairld and $11tig ge, mainwineginiagiteebondidon at all Unieti, Any Obargo d oc-paray, orus. nedubag a building ponit and a nin,
Cedineate d obbupancy 13sub, by Me City of Efto,,ds Suilding MWel.
FINAL PR JECT AT WAL FORM
TOI�
DATE:
MEMO TO: P DIVISION
FIRE DEPARTMENT DATE It (4, 011
FROM: IR
7ENGINEERiNG DIVISION DATE -
DIVISION DATE —
PLANNING
PROJECT
SITE ADDRESS
DATE INSPEC
PERMIT
Z FA6 A-A41 ^�-aj5%
DESCRIPTION OF WORK TO BE INSPECTED
iance with approved plans. Final approval denotes that
A field inspection was conducted to determine compl
there are no objections from the above signed Department to the granting of
v"�' Final approval of the described work
__2��IGRANT FINAL PROJECT APPROVAL
D
e GRANT PROJECT APPROVAL WITH CONDITIONS NOTE
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
I
2.
3.
____RE -INSPECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
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