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PERMIT EXPIRES
CITY OF EDMONDS
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IVISTED DATE
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PERMIT LIMIT.
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
;A P T E CITY OF
PLiCANT ON BEHALF OF HIS OR
I, DEFEND AND HOLD HARMLESS T
E'INT'RE ST, AGREES TO :NDEMNIFY� OM ANY AND
MOND WASHINGTOW� TS OFFICIALS� EMPLOYEES. AND AGENTS FIT
ALLCLAIMSFORDA AGESOF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
NT OF ANY CITY ORDINANCE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REOU'REME FIX NANC E PROVISION, -
NOR LIM IT IN ANY WAY THE CITY S ABI LITY TO E N FORCE ANY 0
I HEREBY ACKNOWLEDGE THAT I HAVE READ THI S AFPLICATQN� THAT THE INFOR-T—
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMP WITH CITY AND STATE LAWS REGULATING CONST.UC
TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIGLAT ION OF THE LABOR CODE OF THE S TE OF WASHINGTON RELATING TO
WORKMENS COMPENSATION INSURANCE AND RCW 18,27.
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ATTENTION' t/ MA 1 00.3
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDI NG OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109 FAX
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el/18/2001 10:57 253-946-2567 ACCESS ELEVATOR INC PAGE 02
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uA ELP-VOR
RECEIVED
N
JAN 8 2001
STATE OF WASHINGION
DEVELOPMW SERVICES
LA BOR AND INTDL)51'R
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DEPARTMENT OF
)FIevator Seed011,
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rost offic!e Box 44480
olympia, Was-nington 98504-4480
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(360) 902-61-10 i
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FAX (3 60) 902-6132
IDEARBUJILDING OFFICIAL! for
a convoyanco listed below
deParIff'8111's attention that th Is Propose rod and
to of this farm Is I"
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This form lor Ing$ your c1lon. Your approval
installation In an kisling building withIn your juriodl elation prohibit
Installation Applicati on. It You hsv* any reg
m 0,
__10
0
will accompany the Installer's
this Install ation, please notify the installeri and d9 JIM appr9V9 this form.
C
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nelined Wheeloliair Urt it, a floor. ASME A114 I Rule
In
10
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V erlical Wheelchair Llfi (the travel shall not ex coed 12 nor penetrate
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Inclined ChaIr Lift
NOT most accessib. 111Y fequireme+s)
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Limited use/lImited 3PP IIC.Ijon (LULA)i elevOlOW* (do"
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All conveg ances shall be installed to code, Any davlotl( ln from the Code shall r equito a variance fro the
$action to a permit being is'--
ITT ITT
DepATIMOn t of Labor and industries Elevator prior
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Date
nt will spprove LULA elevator& In 4XIBIlIng hot
NOTE! TO BuILOING OFPICIAL: The depart-6 Please be SIN
I to NOT r6quirsti, vsrWAC-5`11-10-11105 and ULA
oll, Where an elevator tar is not required.
If* an elevator to be accabsible even Whom on @lava
the&* 0 actions requ hones your approval Is required the
At,
sievators 00 NOT Meet a ccossibility F04U,rernoritst
author fly having jurividiction.
It you have any Questions- please contact us at the letterhead address or telephone number. I
FINAL PROJECT APPROVAL FORM c4yyl 1
TO:—
DATE: —
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE —0(—
ENGINEERING DIVISION DATE —
PLANNING DIVISION DATE —
PROJECT
SITE ADDRESS I
PERMIT DATE INSPECTED
B#_
DESCRIPTION OF WORK TO BE INSPECTED CLCCIA2�IZ
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
—GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
E D
OUTSTANDING ISSUES
_______YAILED FINAL INSPECTION JUN 2 2 2001
DUELOPMEN' CTR
Cily OF EDMONDS
2.
3.
—RE-INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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PLAN CHEC 0:
PLUMBING
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED* THIS PERMIT COVERS WORK TO
BE ONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
DOMAIN C.R.S. SIDEWALKS, DRIVEWAYS , MARQUEES, ETC.1 WILL REQUIRE
SEPARATE PERMISSION.
STATE SURCHARGE
PE MIT APPLICAT1.14:B60 DAYS
PERMIT LIMIT. I YEAR"PAOVIDED WORK STARTED WIT WIN 186,DAYS
K OF PINK PERMIT FOR MORE INFORMATION
SEE BAC F M
REf(FW FEES
'A ON BEHALFOF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
, ;APPLICANT.
1� N NTEREST. AGREES TO INDEMNIFY DEFEND AND HOLD HARMLESS THE CITY OF
AND
LANDSCAPING
I EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES. AND AGENTS FRO. ANY
AULCI-AIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLYOR INDIRECTLY
INSPECTION FEE
REC IPT
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I FR M THE ISSUANCE 01 THI PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
DEXED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
ENFORCE ANY ORDINANCE IS OWSION.'
0 NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE IN' A.AT,oN
APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
Th—ppl-l— I. n,t.p,IjI,,gnldbY nD
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS RIGUITING CONITOUC*
Olf,$ , h.1/hol Dopoty: and FO.a — p.4 nd
TION� AND IN DOING , 0 WILLBE EMPLOYED
HE WORK AD HOSIZED THEREBY. NO PIERS N i?,
ON RELATING
... plil-knowledg, a, p... p—d.d.
TION
DE OF THE STATE OF WASHINGT
IN VIOLATION OF THE LABOR CoT
WORKMEN'S COMPENSATION INSURANCE AND RCW 18,27.
SIGI.ATLI
OF D�
'tNT
�G�r;E (OWNER OR�
DATE SIGNED
DIE SIG110
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(425)
771-0220
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K00riD BY DATE
ATTENTION
EXT 333
TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
7711-0221
IT IS UNLAWFUL
HAS BEEN MADE AND APPfOVAL OR A CERTIFI-
ORIGINAL -FILE YELLOW -INSPECTOR
A FINAL INSPECTION
OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER - COLD - ASSESSOR
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