20020821.pdfDATE RECEIVED
PERMIT EXPIRES
CITY OF
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ZONE PERMIT _�o
EDMONDS
NUMBER
CONSTRUCTION PERMIT APPLICATION
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VESTED DATE
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Plumbing
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THIS PERMIT AUTHORIZES ONLY THE W RK NOTED, THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE FUND
Grading
DOMAIN (CURSE, SIDEWALKS, DRIVEWAYS, MARQUEES, ETCt WILL REQUIRE
lz SEPARATE PERMISSION.
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PIEFIMITAPPIJCATI : INDAYS
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PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
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SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHAL OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit &n—
IN INTEREST, AGREES To I DEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
SHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
#
EDMONDS.
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Receipt
-
FROM THE I SUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT HE
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Total Amt. Due
1
S DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CHYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
R carding Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT � H VE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT AM THE OWNER. OR THE DULY AUTHOR ED AGENT OF
THE OWNER. I AGREE TO CO PLY WITH CITY AND STATE LAWS REGULAT114Q CONSTRUC-
CALL
Thl-ppli.ali-A n p.mrLIFFrpsd by .
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LA '6 "' OF THE STATE OF WASHINGTON RELATING TO
1116,' OffiseFl., hreharDeputy: ard Fees are pard,ad
FOR INSPECTION as'P'fF.F,knI.dgad ri.pres. P'. sea.
WORKMEWS COMPEIN�;g%.U�A�.E AND CVV Is III.
AILE SI ATURE
IGNATURE (OW DATE SIGNED
-771 �-0220
ECA '2A
SE, BY
ATTENT)bN
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNT1(
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI
ORGINAL-FILE - YELLOW-INSFECTO11
CATE OF OCCUPANCY HAS BEEN GRANTED. UBG SECTION 109
PINK OWNER COLD -ASSESSOR
04102 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN ACCOUNTING
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FINAL PROJECT APPROVAL FORM
TO"&
DATE:
MEMO TO: PERMIT COORDINATOR, 13UILDING DIVISION
FROM: FIRE DEPARTMENT DATE -
ENGINEERING DIVISION DATE-
��PLANNING DIVISION DATE
PROJECT
SITEADDRESS 4M
pERMrr �.ADB#________-DATE INSPECTED-
.10 -
DESCRIPTION OF WORK TO BE INSPECTED-N���
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 t e re e se of
PERFORMANCE BONDS and the granting of:
��-�GRANT FINAL PROM CT 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/contractorby inspector
2.
3.
RE-INSpECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
Date_ Sign_
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