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CONSTRUCTION PERMIT APPLICATION Gg
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Plan Check No.
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MECHANICAL
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T115 Permit covers Work to be done an private property ONL .
IS A L L
GRADINGIFILL
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A., CORS, ru on the public domain (CU rbs, side-Ilks,
n
d.w.,S, m=es, etc,) will require separate permission.
-T - R H A G E
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Parm I Application: 180 Days
_SURCHARGE
A NA G E F E E
STORM DRAINAGE FEE
-To.. D I
Pem: t Limit: I Year - Provided Work Is Started Within 180 DSyS
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"Applicant, on behalf of his or her spouse, heirs. assigns and
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P T 0 N F E E
END, INSPECTION FEE
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successors in interest. agrees to indemnify, defend and hold
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harmless the City of Edmonds. Washington, its officials,
B
'as
e mployees, and agents from any and all claims for damages of
' ance
IT from the Is B Uanc'
w atever nature, arising directly or indirectly
ad to
OF ,Is permit slarl not be deemed to
FL-AN CHECK DEPOSIT
FN B N ECK E ro",
OF "I, permit. Issuance
' an CS
modify, waive or reduce any requirement of any city ordln.n co
"ance
nor limit In any way the Clty*s ability to enforce any ordinance
TOTAL AMOUNT DUE
T.TA ' A M - U N, DUE
provision."
I thereby acknOWiFEC198 Itce I RiSy', read lhlzh�ppftallcn; 11,1 Fin
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ATTENTION
APPLICATION APPROVAL
Information given 'Or'. Er I 'at I am a owner or the duty
y
authorized agent of the owner. I agree 10 comply vi�th city and
THIS PERIMIT
This application,is not a permit until
No I'.
state laws regulating construction; and Indoing thework authoriz
AUTHORI E S
A UN OR Z E,
THE
signed by the Bui ding Official or his/her
I pc
ed hereby, no person will be employed in violation .1 the Labor
r
ONLY
No
IN 0, E .
WORK TED
Deputy; and fees are paid , and receipt is
Cc a of the State of Washington relallng to Workmen's Compensa.
acknowledged in space P, oy.ded.
lion Ins slid 18,27.
uranc
IG14TURE (OWNER OR GEN
INSPECTION
DEPARTMENT
DATFL
CITY OF
EDMONDS
211
CALL FOR
By
ENTION
INSPECTION
IT IS UNLAW FUL TO USE OR OCCUPY A BUII.DING OR STRUCTURE
HAS SEEN MADE AND APPROVAL OR
O.IGINAi- - Fo. YIE11L.W - ,Spector
UNTIL A FINAL INSPECTION
A CERTI, r CATE OF OCCUPANCY HAS BEEN GRANTED. UBC
771-0220
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: �FIRE DEPARTMENT DATE—L4—
ENGINEERING DIVISION DATE —
PLANNING DIVISION DATE—
PPnTPrT f)�-r-
SITE ADDRESS 1!�-4- K
PERMIT # #_______pATE INSPEC
DESCRIPTION OF WORK TO BE INSPECTED US CA70
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 granting of:
Final approval of the described work
�:_GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
I RECEIVED
FAMED FINAL INSPECTION - OUTSTANDING ISSUES AUG 10 2001
DEVELOPMENT SERVICES CTR.
CITY OF EDMONDS
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACK61 ....................
FOUNDATION:
Fooling ....................
Wall.......................
Pier/Porch ................
RetainingWall ............
Slabinsulation ............
PLUMBING:
Underground . . ..........
HF�ATING:
GasTest .................
Gaspiping ................
Equipment;;:; ........
Commercial Final .........
b
EXTERIOR SHEATHING
NAILING ....................
FRAMING ....................
INSULATION:
Floorinsulation ...........
Wall Insulation ...........
Calling Insulatlon .........
SHEETROCK NAILING ......
SPECIAL INSPECTION ......
MISCELLANEOUS
FINAL APPROVAL
FOR OCCUPANCY..
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PERMI.T.
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METERSIZE
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NO. OF F=URES
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REMARKS
ENGINEERING MEMO DATED AEVIEWEDSY
MO DATED REVIEVIEDBY
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SERA REVIEW
COMPLETE I EXE
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FINAL INSPECTION REOUIRED
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Plan Check No.
P I a n C
N C A L
MECHANICAL
U H A
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r 0 0 r I 0 IN L Y
This Permit covers work to be done on private property ONLY.
T If I 5 P a r m C 0 v e 3 P P y
F L L
GRAOINGIFILL
R A D N 0
t Id a W k a
Any construction on the us IC domain (Curbs, sidewelk
A n y c 0 n U C I
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driveways. marquees, etc.)Pwilll require separate pormisall
d r I v e w a Y m U P
ST SU C H A G E
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th I n 60 D a Y
P:nRI1 Limit: I Year - Provided Work Ili Started Within 160 Days
P I f L I I Y If
ST A IN A a E F E
MOT
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"Applicant, On beha�! grhis ortpejr�SPOU�51- 5, Seel n and
A p I I 0 b g
0 I a n d an d h 0
,�'Idl.l I Shold
r a as dem d
Successors in Mares tend and
s u C e G n
0 n 5 0 if ici.
n armless the 0, Vdmonde�,dW.,,til.,lIngl.n. 11. Iatflci.S.
h in If I
3 f 0 r d a M a'
a 0 as n CHyn '. fro. any I Ilimr; for damages
If ag '
p I y "a
Orin
to m I In a suan
Wh. Y directly of indirectly frombthde Iss
'P�.Y:r a as
It I Y r in I at
not be d med
of this permit. Issuance of this permit shall not so
of I If 'a P r I
Any C Ity Ord ina n
modify, waive or reduce any requirement of any city Ordinanc
mod HY' we' or
nce any Ord I nance
nor limit In any way the CIty*S ability to enforce any ordinanc:
n "T" I n any we
d EN IN S P E I 0 N F E E
El
is
of
0
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IT
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0 PLAN C CK D 0 S
0 H
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OU IN DUE
TOTAL AMOUNT DUE
TOTAL A M
provision."
a av I e- Is p pi a ion t t
I hereby acknowledge that I In ad this a plication; that the
inform tion given is correct; and m the owner, or the duly
, a jis w I city
author d agent of the owner. I agree to comply With oil I y and
z. in It in I
at" I Ize - ne.uIUfn. din I a wor SO or z.
state laws r doing the work authoriz
W gu'a"ng
ad lih Has, no persE cons""C"On4laonyed In violation of the Labor
ad thereby no person will . am
mpensa
ode of th 0 Stale of Washington relating to Workmen's Compensa-
C e of the . Slide Or,
tion insurance Eric RC N 18.27.
�E,
TT
ATTENTION
THIS PERMIT
T 0 A ZES
Au I
AUTHORIZES
ONLY THE
TED
WORK NOTED
INSPECTION
APPLICATION APPROVAL
This application is not a permit until
signed by th Building Official or his/her
8
Deputy; and fees are paid, and recelpt Is
acknowledged In space prmided.
AT
rH. TuRE OWNER 0. 1 E SIGNED
SIGNATURE 11 - -
DEPARTMENT
C OF
ITY OF
EDMONDS
OFFICIALS SIG ATURE
CALLFOR
RELEASerrey PATY
ATTENTION
INSPECTION
IS WAL INSPECTION HAS BEEN MADE ING R S' FIE
UNLA FUL TO USE OR OCCUPY A BUILDI
IT ND0AFF-'-,cATL"OR
UNTIL A Fl . UBC
A CERTIF I CATE OF OCCUPANCY� HAS BEEN GRANTED
SECTION 109
771-0220
ORIGINAL - File I nW - Inspector
- Own - ASS SSOI
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