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THIS PERMor AUTHOR- RMff COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBuc
Grading
DOMAIN (CURaS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PE MITAPPLICATIOM: I.DAYS
Engir, Review
PERMIT LIMIT. I YEAR -PROVI ED WORK 18 STARTED WrtHIN 180DAYS
Engr. Inspection
SEE a ACK Of PINK PERMIT FOR MORE INFORMATION
1APPUC NT. ON BEHALF 0 HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chit. Deposit
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Fire Inspection
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FROM THE ISSUANCE 11111111 FERMI I ISSUANCE 01 11111 PERMIT SMALL NOT B
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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Total Amt. Due
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NOR LIMIT IN ANY WAY THE CI MS ABILITY 10 ENFORCE ANY ORDINANCE PROVISION..
Recording Fee
Receipt #
I HERE ACKNOWLEDGE THAT I HAVE RE 0 THIS APPLICATION; THAT T14E INFORMATION
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APPLICATION APPROVAL
GIVE IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
T E OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGUIATING CONSTRUG.
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CALL
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TION; AND IN DING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
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Junt Offid.1 his/her Deputy: and Fees tue paid, and
FOR INSPECTION —.1p, 1, axka-1Vdq.dI in sp ... p—Id.d.
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WORKMEN'S COMPENSATION INSURANCE AND RCW 1&27.
OFFICIALS SIGNATURE ATE
DATE
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771-0220
DATE
ATTENTION
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORGINAL-FRAI YELLOW. INSPE46OR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER GO D-ASSESSOR
04102 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN ACCOUNTING
FINAL PROJECT APPROVAL FORM
TO.-_
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: YIRE DEPARTMENT DAT�3-2--21-02
ERING DIVISION DATIE�—
PLANNING DIVISION DATE�—
PROI
SITE ADDRESS
PERMIT #�2 �O2 �Co AI)Bh�_DATE INSPECTED 7 —02
DESCRIPTION OF WORK TO BE INSPECTED--)E� AC ACA-12-11"
A field 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
P_ERFORMANCE BQNDS 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
a 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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