20060249.pdfDATE BECIIIED
PERMIT EXPIRES
IPERMIT
CITY OF EDMONDS
NUMBER
CONSTRUCTION PERMIT APPLICATION
100
ADDRESS
OWNER NAMONAME OF BUSINESS
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THIS PERMITAUTHORVES ONLYTHE WORK NOTED. THIS PERMITCOVERS WORK TO
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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Mechanical
DOMAIN ICURBS, SIDEWALKS, DRIVEWAYS. MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION,
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PERMIT APPLICATION: SEE ECDC 19.0040S(A)(S)
PERMIT LIMIT" SEE ECOC 19�00'006(A)(6)
Engr. Review Recording Fee
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Eogr. Inspection Plan Chk. Deposit
ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESSORS
;APPLICANT�
INTEREST, AGREES TO INDEMNIFY, DEF No AND HOLD HARMLESS THE CITY OF
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M EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
A L CLAIMS FOR DAMAGES 0 WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
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FROM THE ISSUANCE OF HIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
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NOR LIMIT IN ANY WAYTHE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVE' OW
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APPLICATION AP 6-vA:L
[HERE Y 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
CALL Th,X App,,.— ,, —.1 .19— IT, -
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
FOR INSPECTION 8,.Id,�, Wlh�l 011 — F ., I �nA
TION; AND IN DOM THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
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IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPEN 0 RANCE AND ACW 1817.
OR LkLS IGH RE DA E
(425) -3b
DATE SIGNED
771-0220
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FILE Day DA E
EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI.
ORI INAL FILE - YELLOW INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 I IBC110 / IRCIIO.
NK -OWNER - GOLD ASSESSOR
6105 PRESS HARD - YOU ARE MAKING 4 COPIES
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMOTO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: —FIRE DEPARTMENT DATE!-
--ENGINEERING DIVISION DATE
PLANNING DIVISION DATE —
PROJECT )L
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PERMIT#�� �—.ADB4_DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine compliance with -approved plans. Final approval
denotes that there are no objections from the above signed Department to the release of
PERFORMANCE BONDS and the granting of: F11_,C 0
1\10 0&1VJe)uS S,1-613
GRANT FINAL PROJECT APPROVAL D k-- 6
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fonns:ocap"1 3/25/04
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Permit Inspection Details
Permit: BLD20060249
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03/3012006 sMIth 35 APPROVED
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Total Time: 35
Total Inspections:
Total Time: 35
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