20020410.pdfDATE RECEIVED
FPERMITEXPIRES _122
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION JOB SUITEJAPT#
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
c: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION, ONTHEPUSJC
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DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS MARQUEES, ETcJ WILL nioutni
1 WILL .. Bar.
SEPARATE PERMISSION.
Recording Fee
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Engr. Review
City Surcharge
P6RMffAPPUCATI N: INDAYS
PERMIT UMM I YEAR - PROVIDED WORK IS STAOTSO WITHIN 1000AYS
Engr. Inspection
State Surcharge
See BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF 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
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY A140
._ CLAIMS Pen DAMAGES OF WHATEVER NATURE.
Fire Review
Receipt #
ARISING DIRECTLY OR INDIRECTLY
FROM THEISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT $HALL NOT BE
DEEMED TO MODIFY. WAIVE On REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Fire Inspection
Total Amount Due
o NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
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Receipt#
INERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT I AM THE OW ER OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
11111
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN$ COMPENSATIO NCE A D RCW 1827.
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a., 'hj Irprdy: and Fees are paid, and
FOR INSPECTION I..�lp�i...k..wi.dg�di,spamp,vid-od.
SIGIVATURS DATE SIGNED
(425)
IIG�ATURI DATE
771-0220
RELEASED BY DATE I
ATTENTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
771-0221
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
ORIGINAL -FILE - YiLLOW-APEC'TO
10104
FAX
PINK�OWNER - GOLD�ASSESSOR
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: pERWr COORDINATOI;� BUILDING DIVISION
FROM: ME DEPARTI�IENT DATE
ENGINEERING DIVISION DATE._:�1�2-
PLANNING DIVISION DATE—
PROJECI�_
SITE ADDRESS
PERWr# '206"-AD ADB# DATEINSPECTED
DESCRIPTION OF WORK TO BE INSPECTED.—,
A field inspection was conducted to determine final compliance ved 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
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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