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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
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t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
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SMRATEPERUISSION.
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PE MITAPPLICATION: INDAYS
PERMIT LIMM I YEAR PROVED IS WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
See BACK OF PINK PERMIT FOR MORE INFORMATION
*APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS A SIGNS AND SUCCESORS
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Plan Chk. Deposit 16,
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IN INTE EST, AGREES TO INDEMNIFY� DEFEND AND HOLD HARMLESS THE CITY OF
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EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
Fire Inspection
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Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE tSSUANC OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
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Total Amt. Due
Tot., Qu Due
0 CITY N Nc�
DEEMED To MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINA CE
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I HEREBY ACKNOWLE GE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
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APPLICATION APPROVAL
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GIVEN IS CORRECT; AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT Of
THE OWNER. I AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
This appi saran Is ans a paran-111 signed by the
TION� AND IN DOING THE WORK AUTHORIZED THEREBy. No PERSON WILL BE EMPLOYED
8,11 ding Oflic�nd or 1,19/hOl D,pnty: and Fees are paid, and
IN VIOLATION OF THE LA 0 OF THE STATE 0 WASHINGTON RELATING TO
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FOR INSPECTION
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IS WORKMENS COMPENSAN SOG`NCE AND LOW 1.21,
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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.
ORIGINAL rIdLE �EL'LOYV -INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED, USC SECTION 109
PINK � OWNER GOLD -ASSESSOR
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DEPARTMENT OF BUILDINGS
PER UNIFORM BUILDING CODE SECTION 109
At. 731,10 216s' #130 St SW EdM6nds. WA 98026 Building Permit 2002-0 )76
Occupancy established by this certificate: Dwelling Units: **N/A** No. Stories: 3
B
Typq�Oonstructlon: 11 1HR Sprink Basement: Yes
Maximum 61CCU�i;ii.t vM.B.C. 1002)
--(Pe
Room CapacHy signs, wb6r�m
quired, must remafn Posted at airtimes.
owner of Building: S ns a Ica
M d' I dmo, ds WA 28026
THE Blood Draw HAS BEEN INSPECTEO.,�#�ND:APPRqVtD��A13,'�CQM,�?4.Y.,!!,4;3'WIT" THE REQUIREMENTS OF THE IM7—EDITION OF THE
UNIFORM BUILDING CODE AS ADOPTED BY*THE;Ir 1, FOR TA R�MD DIVISION OF OCCUPANCY AND THE USE FOR WHICH THE
P TY #,:GRq4,,
PROPOSED OCCUPANCY IS CLASSIFIED.
Cif, June 2003
Issued thIs j7tb-�` day
CHIEF CIAL
BY:— 41ith�
�tfic.Wf0mupa,,yMuWbytNCftydEd�,dsBukdingOftiW.
FIN* PROJECT APPROVAL
TO:
DATE:—
T%IEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FIRE DEPARTMENT DATE
FROM:
ENGINEERING DIVISION DATE
PLANNING DIVISION DATE—
PROJECT—Sfi!���/"h'
490 ........ ....
SITE ADDRESS
PERMIT #1,2�— 2�L_ADB#___--DATE INSPECTEI
DESCRIPTION OF WORK TO BE INSPECTED----�--
compliance with approved plans. Final approval
A field inspection was conducted to determine fi rtment to the release of
denotes that there are no objections from the above signed Depa
PE RFORMANCE BONDS and the granting of:
_/GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
u Copy of CONDITIONS given to owner/contractor by inspector
I
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
c3 Copy of CORRECTION NOTICE given to owner/contractor by inspector
I
2.
3.
RE-]NspECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date_ Sign_
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