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PERMIT
NUMBER 2-0,02-1.7
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEIRAME
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DGNE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
MECHANICAL
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DOMAIN (CURBS,SIDEWALKS, DRIVEWAYS, MARQUEE%ETC.) WILL REGUIRE
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18D DAYS
STATE SURCHARGE
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PERMIT APPLICATION:
PERMIT LIMIT-. 1 YEAR � PROVIDED WORK is STAR rED W THIN 180 DAYS
AND SUCCESORS
STORM DRAINAGE FEES
END INSPECTION FEE
'APPLICANT, ON BEHALF OF His OR HER SPOUSE, HEIRS, ASSIGNS
DEFEND AND HOLD ARMLESS THE CITY OF
IN NTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD
AND AGENTS FROM ANY AND
EDMONDS, WASHINGTON, ITS FFICIALS� EMPLOYEES,
ALLCLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
ISSUANCE OF THIS PERMIT SHALL NOT BE
FROM THE ISSUANCE OF THIS PERMIT
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DEEMED TO MODIFY, WAIVE OR REDUCE ANY R QUIREMENT OF ANY CITY ORDINANCE
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PLAN CHECK DEPOSIT
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION
I OTAL AMOUR T DUE
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFORMATION
AUTHORIZED AGENT OF
APPLICATION APPROVAL
TIVEN IS CORRECT. AND THAT I AM THE OWNER. OR TH E DULY
RED NEFT I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
CALL
ThIl APP111,01.1 11 "Ib hbI,qi,,d by the
TION AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN V16LATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
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WORKMEN S COMPENSATION INSURANCE AND ROW 18,27.
DATE
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771-0220
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RELEASED
IT I S UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
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CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
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FINAL PROJECT -APPROVAL I ORM
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MEMOTO: PERMIT COORDINATOR, BUILDING DIVISION
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ENGINEERING DIVISION
PLANNING DIVISION DATE—
PROJECT—
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SITE ADDRESS -
INSPECT
PERMIT
WORK TO BE INSPECTED
DESCRIPTION OF
�: ce wi approved plans. Final approval denotes that
A field inspection was conducted to determine complian th
there are no objections from the above signed Department to the granting of
_________Yinal approval of the described work
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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FINAL INSPECTION OUTSTANDING ISSUES
2.
3.
RE-INsPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
wall ........................ ..
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in ...............
Commercial Final
HEATING:
GasTest ...............
Gas Piping ...........
Equipme nt
Commercial Final
EXTERIOR SHEATHING
NAILING ..........................
RE
FRAMING ......................
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
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A LCLAIMS FOR DAMAGESOF WHATEVER NA RE, AMS 1 0 UY
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DEEMEOTOMODtFY. WAIVE OR REDUCE ANY PEOUIREMENTOF ANY CITY ORDINANC
ORDINANCE PROVISION.'
NOR LIMIT IN ANY WAY THE CITY'$ ABILITY TO ENFORCE ANY ORDINANCE PROVISION. TOTAL,AMOYNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPUCATIOM THAT THE INFORMATION i
AGENT OF APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED
THE OWNER, REETO OMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC CALL D" "pPl' I wped by th,
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TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED d,n F ,, p,id. ,d
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION -6p0l -k-lodged sp- pm~.
WORKMEN S COMPENSATION INSURANCE AND RCW 18,21.
DATE SiGNI'y (425) OF" s D TE
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�El 771-0220
RELEASED ATE
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ATtfNTION A9
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTARE UNTIL YILLO - INSPECTo I rf
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR CERTF. ORIGINAL: FILE ' W
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER, DOLE ASSESSOR
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