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ADDITION
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-VALUATION $
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Description
FEE
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Building
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_:�Lr� TIED DATE
Plumbing
P,um�'m.
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
k: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON
2 THE PUBLIC
DOMAIN
Grading
Rao Olding Fee
ZI (CUADS'SIGEIVALKS' DRIVEWAYS. MARQUEES, ETC.) WIL, BEGUIRE
SEPARATEPERMISSION,
Engr. Review
City Surcharge
FE RMIT APPLICATION: 180 DAYS
PERMIT I.I.I. I YEAR �PROVI ED WORK IS STARTED WITHIN a0DAYS
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 DEIENU AND HOLD HARMLESS THE CITY 01
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Review
I Receipt III
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARtS No DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF IHI PERMIT SHALL NOT BE
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DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Fire Inspection
Total Amount Due
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'OR LIMIT IN ANY WAY THE C17YS AINUTY TO ENFORCE ANY ORDINANCE PROVISION,'
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Landscape Insp.
Receipt #
HERESY ACKNOWLEDGE THAT I RAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT I AM THE OWNER OR 'HE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
THE OWNER . I AGREE TO COMPLY WITH CITY AND STATE LAW 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 THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
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ATTENTION
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EASED BY
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
ORIGINAL,FILE YELLOW -INSPECTOR
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FINAL PROJECT APPROVAL FORM
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DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE_2aLL/-0
ENGINEERING DIVISION DATE-_
_______YLANNING DIVISION DATE
PROJECT,4kLA,6-_5 CLS�L_ &E—AYZALL
SITE ADDRESS P, (17-
PERMIT # 06'�L--7 - ADB#___ DATE INSPECTED__2.2�- Z�_
DESCRIPTION OF WORK TO BE INSPECTED_.�����-
A fleld 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
PEREOMMANCE 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 Sign_
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