20010659.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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ENG. REVIEW FEES
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ENE. INSPECTION PEE
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7jW1,p,11 , 12-0
IHERED ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INIO MATION
APPLFtATION APPROVAL
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTiFl-
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License Number: 586100
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Pursuant to the laws of the State of Washington and the Minimum Licensing Requirements
of the Department of Social and Health Services, a license is hereby granted to
JANICE RUTH BROWN
to conduct and maintain at 911 WALNUT ST
city of EDMONDS, Zip Code 98020 County of SNOROMISH State of Washington
an . Adult Family Home for the care and supervision of adults as follows:
24-hour care for no more than 6 adults
1"Z E C E I VC- D
This license shall be in force from the 29th of August, 2001 subject to suspension or revocation for due cause. SEP 10 2001
This home has a special designation to provide service to persons with: Dementia DEVELOPMENT SERVICES CTR.
CITY OF EDI.IoNOS
Conditions on License, if any:
Licensing Authority
NOTE: The department renewal of a license does not preclude the department 6-ftaking any ion under WAC 388-76-705, based on inspection.
This license Is not transferable, and Is valid only for use by the corporaflon, partuenhip or Individual(s) to whom it is Issued and at the location above described.
Issued by Authority of Chapter RCW 70.12
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTWNTDATE--T---L-�L—&
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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:
Ir
Final approval ofthe described work
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WrIH CONDITIONS NOTED
___yAlLED FINAL INSPECTION - OUTSTANDING ISSUES
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PINK - DWklER COLD ASSESSOR
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