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REMARKS
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VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
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Building Permit City Surcharge
PLAN CHECK NO./) _) 2) 5---- VESTED DATE
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THIS PERMIT AUTHORUES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
It BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
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Engr. Review
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5 PERMIT APPLICATION: ISO DAYS
V. PERMIT ILIMM I YEAR - PROVIDED WORK IS STARTED WTTHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-APPLICAN17; ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review Plan Chk. Deposit
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
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DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITTS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAL
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 sMication is not a permit until signed by th
TION; AND IN DOING THE WORK AUTHORIZED THEREITY, NO PERSON WILL BE EMPLOYED
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771-0220 BY DATE
ATTENTION
EXT 1333
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. UBC SECTION 109
PINK - OWNER GOLD - ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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Final approval
denotes that there are no objections from the above signed Department to
the release, of
PERFORMANCE B_ODMS and the -granting o f:
GRANT FINAL PROJECT APPROVAL
GRAM PROJECT APPROVAL WITH CONDITION S NOTED
a Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES,
i3 Copy of CORRECTION NOTICE given to owner/contractor by inspector.
2.
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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METER SIZE
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NO. OF FIXTURES
PRV REQUIRED
YES E3 No C3
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ENGINEERING REVIEWED BY
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DATE
DATE
VARIANCE OR CU SHORELINEORADS# I INSPECTION BOND
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COMPLIANCE OR
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VALUATION
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Description FEE Description FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit
City Surcharge
PLAN CHECK NO VESTED DATE Plumbing
eeNNOWNee Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLZ ANY CONSTRUCTION ON THE PUBUC
DOMAIN (CURDS, SIDEWALKS, ORNEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION. Engr. Review
PERMFTAPPILICATION: 1180DAYS
PFRUIT ILIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Eng . r. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION -
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Fire Review
-Plan Chk. Deposit
IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY 01
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fir;4-Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
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FROM THE ISSUANCE OF THIS PERMM 18SUANCE OF THIS PERMIT SHALL NOT BE
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Total Amt. Due
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DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CHYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION
APPR L
GIVEN IS CORRECr AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CRY AND STATE LAWS REGULATING CONSTRUC-
CALL
This spip1lication is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Bup&?kg OMP&I or his/her Deputy, and Fees are paid, and
IN VIOLATIO LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
I &!gpt is acknowf!�Wt In space pirTilad.
WORKMENS in�TION INSURANCE AND RCW 18.27.
OF C 6PATURE (_VDA
SIGNATURE E GENn
DAT S -
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VQ:�-
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_216-11 3
771-0220
I.NdED BY DATE
NTION
Off 1333
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. UBC SECTION 109
PINK - OWNER GOLD - ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
GREEN - ACCOUNTING