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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
OPERTY ONLY. ANY CONSTRUCTION ON T EPUSUC
BE DONE ON PRIVATE P S H U
DOMAIN (CURSS, SIDEWALKS, IVEWAYS, MAROUEE . ETC�) WILL REO IRE
GRADINOIFILL
SEPARAT E PERMISSION.
RE MIT APPLICATION: ISO DAYS
PERMIT LIMIT. 1 YEAR . PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ON BEHAL OF HIS OR HER SPOUSE, HEHIS� ASSIGNS AND SUCCESORS
ENG, INSPECTION FEE
;APPLICANT.
N NTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
INSPECTION FEE
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A LCLAIMSFORDAMAGES PWHATEVERNATURE.ARSIN ICTLY OR INDIRECTLY
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FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REOUIREMENT OF ANY CII Y ORDINANCE
PLAN CHECK DE IR
-POSIT
J ORDINANCE PROVISION.'
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY
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TOTAL AMOUNT DUE I 4�
I HERE Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
T E OWNEFL I AGREE TO COMPLY WITI CITY AND STATE LAWS REGULATING CONSTRUC-
CALL T .,p�I . P-11 111 5.911d by III,
TION, AND IN DO NO THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE 05 THE STATE OF WASHINGTON RELATING TO
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FOR INSPECTION
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27,
SIGN DATE
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SIGNATURE K)WNEP OVA�r!E. ATE SIGNED
/�ALS NRE
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771-0220
RELtArSto'B" f 6ATE
ATTENTIO�l
EXT 333
ITISUNLAWF LTC USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPUECTION 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
FINAL PROJECT APPROVAL FORM
TO:
DATE:
I�MMO TO: PERWr COORDINATOI;� BUILDING DIVISION
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PERMrr #1Q2 �—.ADBJ�—_DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTEDL,��-���-��
A lield 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
PEREORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH 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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