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CITY OF EDMONDS
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK To
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION
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PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENG. REVIEW FEES
in *APPLICANT ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
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ENG. INSPECTION FEE
_j IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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LANDSCAPING
4 ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
INSPECTION FEE
X, FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
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RECEIPT
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REOUIREMENTOF ANYCITY ORDINANCIF
PLAN CHECK DEPOSIT
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.
I HEREBY
TOTAL AMOUNT DUE
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ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
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.
APPLICATION APPROVAL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
CALL
This application is not a permit until signed by the
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S
Building Official or his/her Deputy: and Fees ate Paid. and
is
COMPENSATION INS RANCE AND RCW 18.27.
receipt acknowledged in space provided.
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SIGNATUR NER OR JGE�llj �
�0 DATE SIGNED
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OF i�� ALS RE DATE
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771-0220
ATTENTION
EXT 1333
RELEASED BY DA
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS SEEN MADE AND APPROVAL OR A CERTIFI-
771-0221
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
ORIGINAL - FILE - YELLOW - INSPECTOR
PINK
5/98
- OWNER - GOLD - ASSESSOR
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'FINAL PROJECT APPROVAL FORM
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MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
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FIRE DEPARTMENT TE
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PUMP SIGN
ENGINEERING DIVISION DATE
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PLANNING DIVISION DATE
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A field inspection was conducted to determine compliance with -approved plans. Final approval.
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denotes that there are no objections frorn the. above signed Department to the release of
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PERFORMANCE BONDS and the granting of:
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GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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El .,,Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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Copy of CORRECTION NOTICE given to owner/contractorby inpector
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1: temp:bldg: forms: ocaprvl 3/25/04