20000875.pdfDATE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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NUMBER
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ADDRESS /?317 .5avro�r �4
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REQUIRED DEDICATION — FT
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YE 0 No E3
NTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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(TYPE OF USE, BUSINESS RAbIVITY) EXPLAIN:
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NUMB R C L
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REMARKS
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VALUATION
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BUILDING
PLAN CH
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MIT COVERS WORK TO
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PU BUD
G DINGIF-
DOMAIN (CURBS, SID EWALKS, DRIVE S. MARQUEES. ETC.) WILL REQUIRE
AMISSIOW
SEPARATEWAY
RCNARGE
PERMITAIILICATI.N; Il0OAYS
IF PERMIT LIMIT. I YEAR � PROVIDED WORK S STARTED WITHIN 180 DAYS
ENG EVIFW FEES
SEE BACK OF PINK PERMIT Fop MORE INFORMATION
'AP PLICA'Ti"A'.'E."Ll" Rl: Fj HER El.UEE, HEIRS, ASSIGNS AND SUCCESOSS
ENG, INSPECTION FEE
IN MNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
UITSHES . SToNG
AND
LANDSCAPING
2 EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS Fp om ANY
INDIRECTLY
INSPECTION FEE
ALLCI-AIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT,SHALL NOT BE
LAN CHECK DEPOSIT
RECEIPT
EEMED TO MODIFY� WAIVE OR REDUCE ANY REOUIREMENTOF ANY Ty ORDINAN o
ANY ORDINANCE PROVISION
RE P
NOR LIMIT IN ANY WAY THE CITY'SABILITY TO ENFORCE
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INF RMATION
APP ICATION APPROVAL
GIVEN pflCT, AND THAT I AM THE OWNER .1 THE ITUlY AUTHORIZED AGENT OF
IS Co
T IP'ka.— - . P—il UM11.1,-V b, ".
THEOWN" I AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING 00 NSTRUG-
CALL
D0011Y: ..d P d. .�d
TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
OF WASHINGTON RELATING TO
--- INSPECTION ... Pt I, llkl,wl.d,.d 11 P— Pl-vldcd
FOR
IN VIOLATION OF THE LABOR CODE OF THE STATE
WORKMEN'S COMPENSATION INSURANCE AND FICIN 18,27.
o s I N TURE DATE
--SIGNATUl DATE SIGNED
(425)
MsN 4 0&
771-0220
ELEAStD By
ATTENTION
EXT1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPE CTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE . YELLOW ].SPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER - GOLD - ASSESSOR
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FINAL PROJECT APPRONAL FORM
TO:
-DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: —FIRE DEPARTMENT DATE-9--/(--'UJ,-"
GINEERING DIVISION DATE—
LANNING, DIVISION DATE —
PROJECT, OX 7—
SrITADDRES XL2,11V,&e!E7t f"A-21
PERMIT ----,ADB#—DATE INSPECTED4
DESCRIPTION OF WORK TO BE INSPECTED—IDEIJ Af�' P,
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
inal approval of the described work
erformance Bonds associated with the Project may be released
�L—GRANT FINAL PROJECT APPROVAL
_GRANT FINAL PROJECT APPROVAL wrrH CONDITIONS NOTED
___--YAILED FINAL INSPECTION - OUTSTANDING ISSUES
2.
3.
__-----RE-INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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