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PERMIT EXPIRES
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CITY OF EDMONDS
'ERMMIIER,—
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CONSTRUCTION PERMIT APPLICATION JOB UITEIAAT�
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MARINGADDRES 'Lit) FEE S
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NAME MET ER SIZE I
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PRY REQUIRED
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ADDRESS REMARKS
OWNERICONTRACTOR RESPONSIBLE POP EROSION CONTROq DRAINAGE 9
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NAME
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STATE LICENSE NUMBER EXPIRATION DATE CHE
VARIANCE OR CU
SHORELINE OR ADEPI INsPE NO
REG 'D ION POSTED
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0 Yes NO
SIGN A A OHEIGHT
PROPERTY TAX ACCOUNT PARCEL NO.
COMPLETE EXEMPT
ALLOWED PROPOSED ALL OWED PROPOSED
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ALLOWED PROPOSED
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C] ADDITION ';E5��MMERCIAL 0 0 PLIANCEOR
CHANGE OF USE
PARKING LOT AHEA 11-ARM1,1. FIE11-JED BY DATE
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0 DEMOLISH C] TANK Nf� �,E
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REMARKS
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REWD
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VALUATION
FEE
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HEAT SOURCE GLAZING I LOT SLOPE 11
BUILDING (I
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PLAN CHECK NO' ;TED DATE
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTA UCTIo ON THE PUBLIC
GRADING�FILL
D OMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATI N: 180 DAYS
A, PERMIT LIMIT-. I YEAR - PROWD D WORK IS STARTED WIrHUN HIOGAYS
ENG� REVIEW FEES
SEE SACK Of PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF His OR HER SPOUSE, HEIRS, ASSIGNS AND succEsoRs
END. INSPECTION FEE
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
LANDSGAP NO
EDMONDS . WASHINGTON. ITSOFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Qm ALLCLAIMS FOR DAMAGES OFWHATEVER NATURE, ARISING DIRECTLYOR INDIRECTLY
INSPECTION FEE
RECEIPT
FROM THE ISSUA CE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHAIL NOT BE
D EMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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PLAN CHECK DEPOSIT
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NOR UNIT WANY WAYTHECITY'SABILITYTOENFORCE ANYORDINANCE PROVISION,'
TOTAL AMOUN T DUE
I HERE Y ACKNOWLEDGE THAT I HAVE READ THIS APPUCATION� THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN 15 CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
T E OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC�
CALL
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HQN. AND IN DOING THE WORK AUTHORIZ ED THEREBY, NO PERSON WILL BE EMPLOYED
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IN vtOLATI N OF THE STATE Or WASHINGION RELATING TO
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FOR INSPECTION I -PI ---Ndp,i
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SIGNATURZ07a=DATE�NE
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FELEASED8 DAIE
ATTENTION
EXT 333
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 - YELLOW JINSPE&OF�-
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109
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FINAL PROJECT APP VAL FORM
TO -.—
DATE: —
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM. FIRE DEPARTMENT DATE.�S -2--2-
ENGINEERING DIVISION DATE —
PLANNING DIVISION DATE—
PROJECTp—An:!�O(L I
SITE ADDRESS & 0 2!�a ID
PERMIT #J,�Co �03 IN
ADB# SPECTED,
DESCRIpTION OF WORK TO BE INSPECT
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
CE _BONDS and the granting of
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL wrrH CONDITIONS NOTED
a Copy of CONDITIONS given to owner/contractor by inspector
I .
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/coritractor by inspector
2.
3.
RE_INSpECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date_ Sign_
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