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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.1 WILL REQUIRE
SEPARATE PERMISSION.
GR�DINGfIll-L
PERMIT APPLICAIRONL 180 DAYS
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PERMIT LIMIT I YEAR . PROVIDED WORK IS STARTED WITHIN 160 DAYS
ENG, REVIEW
SEEDACK OF PINK PERMIT FOR MORE INFORMATION
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'APPLICANT ON BEHALF OF H SANDSUCC_
OR HER SPOUSE. HEIRS, ASSIGN OCR'
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IN INTEREST. AGREES TO IN'EIS
EMNI1Y. DEI�ND AND HOLD HARMLESS THE CITY OF
a EDMONDS. WASHINGTON, ITS OFFICIALS� EMPLOYEES, AND AGENTS FROM ANY AND
LANDSCAPING
ALL CLAIMS FOR DAMAGES OFWHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
fNSPECTION FEE
FR M THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT NOT B
DEEMED TO MODIFY. WAIVE OR REDUCEANY REQUIREMENT OF ANY CISHALLHANCE
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PLAN CHECK DEPOSIT
REM
NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANYORDINAN CE__ .......
TOTAL AMOUNT DOE
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IHEREB ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
THEOWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONsTRUc-
CALL
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IN VICLAT N OF T NSUFAN E WASHINGTON RE ATING TO
WoFKMqE`NjoS COMFG INSUAAN E AND RCW 18.27,
FOR INSPECTION A
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771-0220
ENTION
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DATE
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
ORIGINAL -FILE - YELL,6w. INSPECTOR v
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FINAL PROJECT APPROVAL -FORM
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DATE.
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE —
ENGINEERING DIVISION DATE
PLANNING DIVISION DATE
PROJECT
SITE ADDRESS
PERMIT #,gZ,��.ADB# 121 �3 / DATE INSPECTED
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DESCRIPTION OF WORK TO BE INSPEC
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
PER granthig of
_FORMANCE BQNDS and the
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WIT11 CONDITIONS NOTED
o Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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RE_INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date_ Sign_
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RECORD OF INSPECTIM
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FIRST FLOOR FRAMING
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SHEETROCK NAILING
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
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OCCUPANCY ................