20020171.pdfPERMIT EXPIRESIM4
CITY OF EDMONDS
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CONSTRUCTION PERMIT APPLICATION
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PLAT NAMEISUBDIVISION NO, LOT NO. LID NO,
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REMARKS
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0 CARPORT 0 ROCKERY RENEWAL
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Description
FEE Description FEE
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PLAN CHECK NO:
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
h: BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLI
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Grading
Recording Fee
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MAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUI .
SEPARATE PERMISSION.
Engr. Review
City Surcharge
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P —4 IT APPUCATION: use DAYS
PERMIT LIM171. I YEAR - PROVID WORK IS STARTED WITHIN INDAYS
Engr. Inspection
State Surcharge
SEE SACK OF PINK PERMIT FOR MORE INFORMATION
--CANL ON 11-LF OF HIS OR HER SPOUSE . HEIRS, ASSIGNS AND SUCCESORS
Traffic Mitigation
Plan Chk Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
W EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
Fire Review
Receipt III
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMB. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDU E ANY REOUIREMENT OF ANY CITY ORDINANCE
Fire Inspection
Total Amount Due
0. NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINAN09 PROVISION.�
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BY
I HERE 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 APPH VAI
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONS
LOYE'.
CALL
This '. IS]
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TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMP D
IN VIOLATION OF THE LABOR ODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND Flow 18.27�
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dingOfficialar Isiher Opuly; ard Fees are PaId, Mal
FOR INSPECTION fecolptisock,owledgedinspa,op,mided.
SIGN
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0 pl�LS �SKINAI DATE
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771-0220
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BE`, EQ�BY BYTE
ATTENTION
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-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
ORIGINAL - FILE - YELLOW - INSPECTO
PINK - OWNER - COLD � ASSESSOR R
10/01
FINAL PROJECT APPROVAL FORM
C9 TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: -FIRE DEPARTMENT DATE,
ENGINEERING DIVISION DATE�__
PLANNING DIVISION DATE
PROJEC, IA161
SITE Anng ss 6_kCx_1fz_ 9;7—
PERMIT 1 -----ADB# ___________DATE INSPECTED-- 3-13
DESCRIPTION OF WORK TO BE INSPECTED PUAe (Z"ae C-Ae
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
PERFORMANCE BONDS and the granting of
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
u Copy of CONDITIONS given to owner/contractor by inspector
1
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign_
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