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Description. FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE
Building Permit City Surcharge i
CHECK NO: Plumbing 0o Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK To Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC Grading
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
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PERMIT LIMIT: SEE ECDC 19.00,005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION 0 0
S Fire Review Plan Chk. Deposit
*APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSOR
uj MILESS THE CITY OF
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HAR
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
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapeinsp. Total Amt. Due
C NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
xi 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 This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLYIWITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building official or his/her Deputy: and Fees are paid, and
TION; AND IN DOING THE WORK APTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED I receipt is acknowledged in space provided.
IN VIOLATION HE LABOR qODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S PEN
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ATTERTION, EXT. 1333
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IT IS UNLAWFUL TO
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL FILE YELLOW INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 I IRC111.0. PINK -OWNER.- GOLD - ASSESSOR
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FINAL PROJECe APPROVAL FORM
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MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASE SIGN
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DESCRIPTION OF WORK TO. BE. INSPECTED
A field inspection was conducted to d etermine compliance with approved plans. Final approval
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PERFORMANCE BONDS and the granting of:
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED.
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECTAPPROVAL'.
Date Signature
1:tenip:b1.dg:f6rms:ocaprv1 3/25/04