20020364.pdfDATE RECEIVED
CITY OF EDIVION S I
CONSTRUCTION PERMIT APP7LICATION
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OWNERICONTRACTOn RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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THIS PERMIT AUTHORUES ONLY THE WORK NOTED. THIS PERMIT _ COVEnRSWORKTO
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1: SEDONEONPRIVATEP PERTY ONLY. ANY CONSTRUCTION ON THE Pu LID
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Grading Recording Fee
DOMALIN JCURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL IT SQUIRE
t SEPARATE PERMISSION.
PE ""T"PUCATION: 1NDAYS
PERMIT IUMIP. I YEAR -PROVIDED W FIX IS STARTED WITHIN IGODAYS
Engr. Review City Surcharge
Engr. Inspection state surcharge
SEE 13ACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT ON BEHALF 011111 On HER SPOUSE!, H1111. ASSIGNS AND 1UCGES..S
Tratfic Mitigation Plan Chk Deposit
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM A. All'
Fire Review Receipt #
ALL CLAIMS ""' DAMAG" 01 WHATEVER NATLINI ARISIN. DIRECTLY OR INOMECTLY
FROM THE ls�.AbIcE OF THIS PERMIT ISSUANCE OF THIS PERMIT SfMLL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REOUIREMENT OF ANY CITY ORDINANCE
Fire Inspection Total Amount Due L2
NOR LIMIT IN ANY WAY THE CITIS ABILITY TO ENIORCE A. ...INANCS P.O.M.N.'
LandSCapoinsp. Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVEN is CORRECT, AND THAT AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
THE OWNER. JAGREETOCO PLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
appft�fi.n 11� P.1.4-111 �ig�.d by ft
CALL
TION; AND IN DOING THE WORK AUTHORIZED T"EnEUY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
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FOR INSPECTION ... P-1d.d.
WOnKMENa COMPENSATIGN'"NCE AND fICW 18.27.
OFFICIALS,10 DATE
ATT�;E.
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771-0220 RELEASED By ATE
TION
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-
ORIGINAL - FILE YELLOW INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX PINK � OWNER GOLD - ASSESSOR
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TO:_
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: DEPARTNIENT DATE
SENGINEERING DIVISION DATE
G DIVISION DATE
PROJEC
SITE ADDRESS.
PERmrr # ADB#
DATE INSPECTED 02,
DESCRIPTION OF WORK TO BE INSPECTED A-L- 9�VILW
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
a Copy of CONDITIONS given to owner/contractor by inspector
1
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
o Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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FINAL APPROVAL FOR
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