20010921A.pdfDATE RECEIVED
CITY OF EDMONDS
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SEE BACK OF PINK PERMIT FOR MORE INFORMATION
END INSPECTION FEE
' P PUCANT. ON BEHALF OF HI OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
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DEFEND AND HOL 'LES' THE CITY OF
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. C HAT HE INFORMATION
I HE REBY ACKNOWLEDGE THAT I HAVE READ THIS AFPLICATIoN TRIZ
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TtON AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
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SIGN;,PE (OWN DIE SIGNED
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771-02
ATTENTION
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IT IS UNLAWFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-,i
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
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FINAL PROJECT APPROVAL FORM
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MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
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ENGINEERING DIVISION DATE -
PLANNING DIVISION DATE
PROJECT
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PERMIT #,:2� �ADB# DATE INSPECTED -
DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine final compliance with approved plans. Final approval
denotes that there are no objections from the above signed Department to the release of
PERF )RMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 copy of CONDITIONS given to owner/contractor by inspector
1.
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
a Copy OfCoRRECTION NOTICE given to owner/contractorby inspector
1.
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RE-INSpECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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DATE RECEIVED
EXPIRES
PERM
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PERMIT
CITY OF EDMONDS
ZONE NUMBER (�W
SUITEIAPTN
CONSTRUCTION PERMIT APPLICATION
JOB
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OWNER NAIAE/14AIAE .��NES�
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CITY ZIP
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P4.,=PERMITUMIT'.' YEAR '
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
on HER SPOUSE. HEIRS. ASSIGNS AND S.CCESORS
N BEHALF OF "IS D HOLD AMLESS THE CITY OF
DEFEND AN
END. INSPECTION FEE
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TOTAL AMOUNT DUE
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I HEREBY ACKNOWLEDGE THAT I HAVE RE.W T" A OR UC GUL THAT 'IED AGENT -1
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T,ON , F
'N VQLAT N OF THE LABOR CODE Or THE ST TE 0 ASHINGTON
SCO.PENSATtONINSUpANpEANDRCWIB
W.A�MSN�. - 21
DATE
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771 -0220
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BY DATE
EXT 1333
11
OR OCCUPY A BUILDING OR STRUCTURE UNTIL
TO USE ,. 771- 2921
Q. ,
ORIGINAL - I'l OW - INSPECTOR
IT IS UNLAWFUL
HAS BEEN MADE AND APPROVAL OR A CERTI
- I.
PINK -
A FINAL INSPECTION
HAS BEEN GRANTED. U13C SECTION 109
FAX
CATE OF OCCUPANCY
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