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THIS PERMIT AUTHORIZES ONLYTHE WORKNOTED. THIS PERMIT COVERS WORK TO
@E DONEONPgNATEPROPERTYONLY.ANYCONSTLJUCTIONON THEPUBLIC
DOWUN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.I WILL REQUIRE
SEPARATE PERMISSION.
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Engr. Review
PERMITAPPUCATION: IBODAYS
PEIIMITUMR:IYEAR- PROVIDED WORK IS STARTED WITHIN ISODAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Traffic Mitigation
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLE) HARMLESS THE CITY OF
Y EDMONO^u, WRSHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Fire Review
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
9 DEEMED TO MODIFY, WAIVE
Fire Inspection
OR REDUCE ANY REOUIREMENT OF ANY CITY ORDINANCE
i NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Landscape lnsp.
i HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT: AND THAT I AM THE OWNER, 08 THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
CALL
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
WORKMEN'S OMPENS 7RN*i\AND RCW 18.27.
SIGNATUR (O NER AGEN / GATE SI NEq
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771-0220
ATTENTION
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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
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Description
FEE
Recording Fee
City Surcharge
State Surcharge
Plan Chk Deposit
Receipt #
Total Amount Due
Receipt #
77
%PPLICATION APPROVAL
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ORIGINAL - FILE YELLOW -INSPECTOR
PINK - OWNER GOLD -ASSESSOR
FINAL ERWEC'I APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: L- - FIRE DEPARTMENT DATE_ `'� —O
ENGINEERING DIVISION DATE
PLANNING DIVISION DATE
PROJECT %`7z`t2—
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PERMIT #� Oa 2 - J� 3 �� ADB# DATE INSPECTED Co
DESCRIPTION OF WORK TO BE INSPECTED G' % _(_ E� OV 4L
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:
7� . GRANT FINAL PRO.IECT APPROVAL��tc��
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
o Copy of CONDITIONS given to owner/contractor by inspector
1.
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
❑ Copy of CORRECTION NOTICE given to ownerlcontractor by inspector
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2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign
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