20020270.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PERMIT EXPIRES
USE PERMIT
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REMARKS
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STORIES
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JOCCUPANT
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DESCRIBE WORK TO BE
DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 11081FINAL INSPECTION REO'D
VALUATION $
FEE
Description
FEE
Description
Plan Check
LOT SLOPE %
Building
45-
TED DATE
Plumbing
Mechanical,
THIS PERMIT ABYHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DOME ON PRIVATE PROPERTY ONLY. AM CONSTRUCTION ON THE PUSUC
Grading
Recording Fee
00 (CURBS, SIDEWALKS, DRIVEWAYS MARQUEES, ETC.) WILL REQUIRE
MAIN SEPAMTEPERM;SSION.
Engt. Review
City Surcharge
PERMIT APPLICATION: IN DAYS
PERMIT LHIM, I YEAR-PROVI ED WORK IS STARTED WITHIN TO DAYS
-Ergr, Inspection fillf—
State Surcharge e?
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ON 11ML OF HIS OR HER SPOUSE. EIRE ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
. Traffic Mitigation
Plan Chk Deposit
EDMONDS, WASHINGTON� ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Review
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
F80M THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT HE
EE.E.T0 WA VE OR REDUCE
Fire Inspection
Total Amount D lie C45
MODIFY ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION,'
Landscapainsp.1
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVE" IS CORRECT, AND THAT I AM THE OWNER, Oft THE LILLY AUTHORIZED AGENT OF
APPLICATION APPROVAL
THE OWNE . I AGREE TO COMPLY WITH CITY AND STATE LAW REGULATING CONSTRUC-
CALL
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TION. AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
in VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
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FOR INSPECTION
cars Official or hlslhll Dop,ly: ad Foes are orldL and
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WORKkfN'S COJ�PENSATION 11 SURANCE AND DOW 18.27.
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111-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL -FILE IVELLOW-fINSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. U0C SECTION 109
FAX
PINK -OWNER GOLD -ASSESSOR
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
C". FIRE DEPARTMENT DATE
FROM:
ENGINEERING DIVISION DATE
DIVISICINDATE,—
PROJEC 626,-2.&DL -t
SITE ADDRESS 9-,) -2
PERMIT ')-0,0-2-.,--21770---ADB#—___-----.PATEINSPECTED-E��-'P-�
DESCRIPTION OF WORK TO BE INSPECTED-13,J-
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 WITTI CONDITIONS NOTED
u Copy of CONDITIONS given to owner/contractor by inspector
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 Si
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