20000866.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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9 Ee L E M DINACC5 PROVISION." RECEIPT
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TOTAL AMOUNT DUE
IKERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INFORMATION APPLICATION APPROVAL
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IS OR T E DULY AUTHOR Thl, Ippill't— I Pulmit Unt'
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THE OWNER I AGREE To COMPLY WITH.CITY AND STATE LAWS REGULATING CONSTRUC C PlIq OUIP-1 -1 hl 0-1-11
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DOING THE WORK AUTHO tZED THEREBY. NO PERSON WILL BE E .p, �� ��dq�d 1� P� prd�d.
TION; AND IN L FOR INSPECTION
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RE ATING TO
WORKMEN'S COMPENSATION INSURANCE AND SCW 18.27, OFFJOfA N BE DATE
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771-0220 ELE S By
A'FENTIOq EXT 333
IT IS UNLAVVFULTJUSE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221 ::- ORIGINAL - 111. YILLO - INSPECTOR
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI, E -
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109 FAX PINK -OWNER I GOLD - ASSESSOR
5198
FINAL PROJECT APPROVAL FORM
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DESCRIPTION OF WORK TO BE INSPECTED 1+-f 12/ZO
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A field mispection was conducted to determine compliance with approved plans. Final appro v
there are no objections from the above signed Department to the granting of
...... 9--Final approval of the described work
_Performance Bonds associated with the project may be released
........................
GRANT FINAL PROJECT APPROVAL
CONDITIONS NOTED
_GRANT FINAL PROJECT APPROVAL WITH
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FINAL INSPECTION - OUTSTANDING ISSUES
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____---.RE-INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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PLAN CHECK NO: VESTED DATE
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE N 1.1,1VATI IROISFITI NLI. ANY CONSTRUCTI.N ON THE PUBLIC
GRADINGIFILL
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G CUR , BRIEWALKS, DRIVEWAYS MARQUEES. ETO� WILL REQUIRE
SEPARATE PERWISSInN, -- i
STATE SURCHARGE
PERMIT APPLICATION: ISO DAYS
I PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTE.D.WITHIN 180 DAYS
ENG� REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE RIF MATION
A ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Nli.
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;Nplp�LTI�_�IIG A N 'FY. DEFEND AND HOLD HARMLESS THE CITY OF
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RECEIPT
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FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
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DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENTOF ANY CITY ORDINANCE
TO INIO VICE ANY ORDINANCE PROVISION,'
RED IPT
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N 01 LIMIT IN ANY WiWTHE C, ITS ABILITY
TOTAL AMOUNT DUE
JERE Y ACKNOWLEDGE THAT I HAVV READ THIS APILICATION� THAT THE INFORMATION
APPLICATION APPROVAL
.
VENBS CORRECT. AND THAT I A THE OWNER, 08 THE DULY AUTHORIZED AGENT OF
..Ppli-l- I- �-' A P-1-4 U�" '0 b, 11.
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N�11'1�IA.,�RET.TeOWOMP WiTNCITY AND �Ws REGULATING CONSTRUC-
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"N"A AKLAYJTHORIZED THERETABTE
N' Y, NO PERSON WILL
OF WASHINGTON RELATING TO
FOR INSPECTION Q.,,ptjk,ml.d9ldll spato pr.vidad,
V1*6CATION OF THE LABOR ODE OF THE STATE
iRKMENB COMPENSAT ON INSURANCE AND ROW 18.27.
I C
I
OFFICIAL E DATE
1
. (425)
?ATURE (OWNER AG NTI
Z)
771-0220
LEASED DATE
fENTI0q
EXT 333
)
�UNLAWFULTQJUSE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
NIPICTOR
qAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - VILE YELLOW
GOLD - ASSESSOR
OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK -OWNER