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STATE SURCHARGE
MIT APPUCATION: 18D DAYS
P. PERMIT LIMIT-. I YEAPRE- PROVID D WORK IS STARTED WITHIN 18D DAYS
ENG, REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICAN , ON BEHALF F HIS OR HER SPOUSE. HSIRS, A SIGNS AND SUCCESORS
ENG. INSPECTION PEP
J2� IN INTER ST. AGREES TO INDEMNIFY, DEFEND AND HOL HARMLESS THE CITY OF
LANOSCAP NO
2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
INSPECTION FEE
A CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FLL M THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REOWREMENTOF ANY CITY ORDINANCE
PLAN CHECK DFPOStT
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NOR LIMIT IN ANYWAYTHE CITY'$ ABILITY TO ENFORCE ANY ORDINANCE IROV�SION.-
TOTAL AMOUNT DUE
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AU HORIZED AGENT OF
T E OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS 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 T TATE OF WASHINGTON RELATING TO
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FOR INSPECTION Ilklmlodgld 1,, SPIll PI-14.
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WORKMEN'S COMPENS�� VCW 18.27.
DATE
SIGNATU GEN DATE SIGNED/
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OFlICIALS IIGIIAT R
771-0220
—SCLEASED BY
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IT IS UNLAWFUL TO USE 08 OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
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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
PIN�,O.NER GOLD -ASSESSOR
FINAL PROJECT APPROVAL FORM
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DATE:
MEMOTO: PERmrr cooRDiNATOP, BUILDING DIVISION
DEPARTMENT DATE
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RE_INSpECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
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