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CONSTRUCTION PERMIT APPLICATION
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STATE LICENSE NUMBER
EXPIRATION DATE
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P ROGRESS INSPECTIONS PER LISC IOS/FINAL INSPECTION RECtO
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Description
FEE
Description
FEE
Plan Check
State Surcharge
URCE
LOT SLOPE %
Building Permit
City Surcharge
PLAN CHECK NO:
VESTED DATE
Plumbing
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Mechanical
2 BE DONE ON PRIVATE PROPEM ONLY. ANY CONSTRUCTION ON THE PUBLIC
3 DOMAIN JCURSSL SIDEWALKS, DRIVEWAYS MARQUEES, ETC,) WILL REQUIRE
Grading
SEPARATE PERU; SSION.
2 �
Engr. Review
PERMITAPPUCATION: led DAYS
Engr. Inspection
PERMIT LIMIr. I YEAR - PROVIDED WORK IS STARTED WITHIN Into DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICAW, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
PlanChk.Deposft
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON , ITS OFFICIALS, EMPLOYEES, MID AGENTS FRO ANY AND
CLAIMS
Fire Inspection
Receipt
3 ALL FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY ORMIND RECTLY
9 FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED To
Landscapeinsp,
MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
to I NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Total A.L. Due
-HEREBY
Recording Fee
Receipt At
I ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPf
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
TION; AND
CALL
T"s application Is not a permit 0 signed by me
IN DOING THE WORK AUTHORIZED THEREW(, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF TH E
Unit ding OffWal . lae/1,11 Dainty: and Face ale paid, f
LA OF THE STATE OF WASHINGTON RELATING TO
WORKMEN" COMPENSAT 4:?I�RDpCE AND RCVV 18.27.
FOR INSPECTION
receipt Isacklowledged I.ap.a.,pio,fid.d.
SIGNATU
(425)
771-0220
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B6LIA B D47E
AM110ION
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-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
ORIGINAL -FILE YELLOW -INSPECTOR
04102
PINK -OWNER GOLD -ASSESSOR
PRESS HARD -YOU ARE
MAKING 5 COPIES GREEN - ACCOUNTING
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DATE:
MEMO TO: PERMIT COORDINAT01?, 13UILDING DIVISION
FROM: FIRE DEPARTMENT DATE
ERING DIVISION DATE
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A field inspection was conducted to determine final compliance with approved plans. Final approval
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denotes that there are no objections from the above signed Department to the release of
PERFORMANCE BONDS and the granting of:
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GRANT FINAL PROJECT APPROVAL
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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a Copy of CORRECTION NOTICE given to owner/contractorby inspector.
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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