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PERMITEXPIRES
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CITY OF EDMONDS ZONE PERMIT
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CONSTRUCTION PERMIT APPLICATION JOB SUITEIAPT#
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Description
FEE Description FEE
ADATE
Plan Check
State Surcharge
HEAT SOURCE GLAZING
LOT SLOPE
Building Permit
,I, Surcharge
PLAN CHECK NO:
VESTED
Plumbing
X
THIS PERMIT AUTHORIZES ONLY THE ORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTR CTIONONTHEPUBUC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS MAROU ES, ETC.) WILL REQUIRE
SEPARATEPERM;SSION. E __
PER IT APPLICATION: ISO DAYS
Mr
PERMIT LIMIT. I YEAR -PROVIDED WORK IS STARTIED WITHIN ISODAYS
SEE BACK Of PINK PERMIT FOR MORE INFO MATION
Mechanical
Grading
Engr. Review
Engr. Inspection
9 'APPLIC I, ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
IN INTERMEST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
IA 1. CLAIMS FOS DAMAGES OFWHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Fire Review
Fire Inspection
Plan Chk. Deposit
Receipt #
9 FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
.1 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY C TY ORDINANCE
N LIMIT IN ANYWAY THE CITYS ABILITY TO ENFORCE ANY ORDINANG_111_151_1_
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Total AGRI, Due
1.0a —_
Recording Fee
I HEREBY ACKNOWLEDGE THAT � HAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVE" IS CORRECT, AND THAT AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUG.
TION; AND IN DOING THE WO RIZED THERE , NO PERSON WILL BE EMPLOYED
VIOLATI
IN ON OF THE BE F THE STAT OF WASHINGTON RELATING TO
WIDBIMINSCOMPENS N INS RAN AND±CW 18.27�
CAL
FOR INSPLTION
(425)
771-0220
PPROVAL
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FLEASED 1Y ATE
ATTENTION
EXUT 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 - iNSPEC
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FINAL PROJECT APPROVAL FORM
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DATE:—
MEMOTO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: —FIRE DEPARTMENT DATE
ENGINEERING DIVISION DATE
PLANNING DIVISION DATE._
PROJECT
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PERMIT —_AD13k--DATE INSPECTED
DESCRIPTION OF WORK TO 13E INSPECTED_Wj—�(.) p,
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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
PERFORMANCE BONDS and the granting of
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
U Copy of CONDITIONS given to owner/contractorby 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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