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THIS PERICTAUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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3 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES,ETC-) WILL REQUIRE
SEPARATEPERMISSION.
Engr. Review
City Surcharge
RE MITAPILICATION: ISDONTS
PERMIT UNNE 1 YEAll - PROVID WORK IS STARTED WITHIN IN DAYS
Engr. Inspection
State Surcharge
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-ILICANT ON BE-11 01 HIS On HER SPOUSE. "EMS. AISIGNIAND 1UCDES..S
Traffic Mitigation
Plan Chit Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
AGENTS Flo" ANY AND
Fire Review
Receipt #
EDMONDS, WASHINGTON* ITS OFFICIALS, EMPLOYEES, AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR IND RECTIN
FROM THE ISSUANC OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT B�E
Fire inspection
Total Amount Due
DEEMED To MODIFY' WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANC
0 NOR UMO I ANY ORDINANCE P
N ANY WAY THE CrIYS ABILITY TO ENFORCE ROVISION.
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1 HERE ACKNOWLEDGE THAT I MVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THEOWNER. I AGREE TO COMPLY Win) CITY AND STATE LAWS REGULATING CONSTAUC.
CALL
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TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABO BE OF THE STAT OF SHINGTON RELATING TO
FOR INSPECTION
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RELEASE. BY DATE
AIT-ENTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
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FINAL PROJECT APPROVAL FORM
DATE:
MEMOTO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
--- ENGINEERING DIVISION DATE-
--Y'LANNING DIVISION DATE
PROJECT
SITEADDRESS
PERMIT #
,2 ADD DATEINSPECTED
DESCRIPTION OF WORK TO BE INSPECTED -
Afield inspection was conducted to determine final compliance with approved plans. Flualapproval
denotes that there are no objections.frout the above signed Department to the release of
PERFORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
o Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
o Copy of CORRE CTION NOTICE given to owner/contractor by inspector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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