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RECEIVED
PERMIT EXPIRES —4
CITY OF EDMONDS
SF PERMIT
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CONSTRUCTION PERMIT APPLICATION
JOB SUITE/APT*
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REMARKS
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VALUATION
Description
FEE
Description
FEE
Plan Check
LIals, Surcharge
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City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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t BEDONEON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
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DOMAINI (CU BOB, SIDEWALKS. DRIVEWAYS MARQUEES, ETC,� WILL REQUIRE
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PERMA'APPLICATION: ISODAYS
PERMIT LIMIT. I YEAR D WORK IS STARTED WITHIN 180 DAYS
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Engr. Inspection
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SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF F HIS 08 HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
Fire Review PlanChk.Deposh
IN INTE EST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
A N
WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection Rece,p' #
EDMONDS,
[HE
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR MID ECTLY
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THE ISS BE
FROM LANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapeinsp. Total Amt. Due
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ITY CE
DEEMED TO KIDD WAWE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABIL17Y TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee Receipt #
I HERESY ACKNOWLE GE THAT I HAVE READ THIS APPLICATION THAT THE INFORMATION
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APPLICATION APPROVAL
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GIVEN 19 CORRECT', AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
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THE OWNER. I ABBE AND STATE LAWS REGULATING C.NBTIUC,
FLY WITH CITY
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NO PERSON WILL BE EMPLOYED
CALL 8.11"og Offidal or IoWhor Drp.I, oo _
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TION; AN1,1N DOING THE W FIX AUTHORIZED THEREBY,
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IN VIOLAT ON OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
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FOR INSPECTION
WORKMENIS COMPENWT!�94�SU NCE AND RCW 18,27.
a SI.NATYRE DATE
SIGNATURE (OWNER O� AGENT)
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I -IJ,94%J ifELEASED BY DAT)r
ATTENTION-,'
EXT 13331
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE - YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. LED SECTION 109
PPIK-OWNER COLD -ASSESSOR
04YO2 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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FINAL PROJECT APP AL FQR--M
TO:_
DATE: --
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENTI)AT112:11'
ENGINEERING DIVISION DATE—
PLANNING 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 th ere are no objections from the above signed Department to the release of
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GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WrIH CONDITIONS NOTED
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u Copy of CONDITIONS given to owner/contractorby inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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u Copy of CORRECTION NOTICE given to owner/contractorby inspector
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date_ Sign__
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