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PERMIT EXPIRESIC-1
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PERMIT
CITY OF EDMONDS
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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTJON ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS. DRIVE S. MARQUEES. ETC.) WILL REQUIRE
WAY
SEPARATE PERMISSION.
PER ITAPILICATION: l8DDAYS
PERMIT LIMIM I YEAR - PROVID I WORK 15 STARTED WITHIN IM)DAYS
END, REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENG. INSPECTION FEE
ENI
SMCC So'
A S' I N S AN D E
-APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
HA ' THE CITY I
M L S
IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HUD HARMLESS THE CITY OF
A
LANDSCAPING
L
I NTS RIM ANY AND
'D A E
;I EDMONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
D'RECTLYoR INDIRECTLY
m ALLCLAIMS FORDAMAGESOFWRATEVER NATURE, ARISING DIRECTLYOR INDIRECTLY
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q "' PERM" SHALL NOT BE
z FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
ANY CITY ORDINANCE
T OF ANCTT, ORDINANCE
PLAN CHECK DEPOSIT
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9 DEEMED TOMODIFY. WAtVEOR REDUCE ANY REGUIREMENTOF
Y ORDINANCE PREW'S'ohl .
.1 NOR LIMIT IN ANY WAYTHE CITY'SA.Ul TO ENFORCE ANYCI.DINANCE PROVISION.-
TOTAL AMOUNT DUE
To
IR
JRSF
THAT THE ..... ATI.N
I HEREBY ACKNOWLEDGE TH H E READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
AUTH. ED AGENT OF
GIVEN IS CORRECT. AND THAATT: AAMVTHE OWNER. OR THE DULY LITHORIZED AGENT OF
'L' LA PIZ T DO
REGULATING CONSTRUC.
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THEMNER. IAGREETOC m WITH CITY AND STATE LAWS
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TION. wo RK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
CALL
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AND HY DOING THE
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
C
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WORKMEN S COMPENSATION INSURANCE AND RCW 18.27,
OlF%0ALS SIGNATURE
DATE SIGNE
T
'SIGNATU WNER AGENT) A NED
(425)
12 a /
771-0220
710
ENTION
EXT 1333
4D By ATE
-/b/
IT IS UNLAWFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPE CTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
L FL��', 34 - INSPE�TOR
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CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
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OWNERICONTRA0TOR IS
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APPROV
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FINAL-P-R-0-SE-C-T-AP-PROVAL�FORM
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bamo To: PERmrr COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTNIENT DATE—
a"Lj-P__4 8(LLegL_ENGIMEERINGDIVlSION DATE—' I I (t, 102-
PLANNING DIVISION DATE —
SITE ADDRESS___iL��N A ve-
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PERMIT �S�ADB# . . . . . . PATEINSPECTED
DESCRIPTION OF WORK TO BE INSPECTED _F
A field inspection was conducted to determine final compliance with approved plans. Final approval
denotes that there are no objections from the above signed Department to the release of
PERFORMANCE S and the granting of:
-=GRA.NT FINAL PROJECT APPROVAL
.........................................
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
o Copy of CONDITIONS given to owner/contractor by inspector
1.
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contractor by inspector
1.
2.
3.
RE-INSpECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date— Sign_,
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
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07 —014�
SETBACKS .....................
FOUNDATION:
Footing ......................
wait ..........................
Plot/Porch .................
Retaining Wall ...........
Slab insulation ..........
PLUMBING:
Underground .............
Rough -in ...................
Commercial Final
HEATING:
Gas Test ....................
Gas Piping ..............
Equipment .................
Commercial Final
EXTERIOR SHE ATHING
NAILING..........................
FRAMING ............
FiRST FLOOR F R AMING
INSULATION ................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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REMARKS
OVINERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
IP TELEPHONE
NAME
ED AT E
ENGINEERING 41E �ATE
;7; 6
ADDRESS
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DISCRIDEWORITOBE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REO'Dj
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MECHANICAL
THIS PERMIT AUTHORIZ'ES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVAIEIROPERTI ONLY. ANlCO.ST.UCTI.HONTNEPU.-C
GRADINGIFILL
I URBS SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION,
STAT S A HAP
PE MITAPPLICATI10 : 160DAYS
PERMIT LIMIT. I YEARR PROVIDED WORN IS STARTED WITHIN 180 DAYS
ENG. EWE FEES
SEE BACK OF PINK PERMIT FOR MORE INF RMATION
ON BEHALFOF HIS OR HER SPOUSE, HEIRS.ASStGNS AND SUCCESORS
CITY OF
ENG, INSPECTION FEE
;APPLICANT.
N NTEREST, AGREES To ;NDEMNIFY, DEFEND AND HOLD HARMLESS THE
EDMONDS. WASHINGTON, TS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
LANDSCAPING
INSPECTION FEE
A LCLAIMS FOR DAMAGESOF WHATEVER NATURE. ARISING DIAECTLlY.R INDIRECTLY
L NOT BE
LA
FROM THE =,NYC.E OF THIS PEANIII ISSUANCE .1 THIS PERMIT SHALL
C�EIVEEIT. AVE 01 REDUCE ANY REQUIREMENT OF AlYCITY ORDINANCE
ANY ORDINANCE PROVISIOW'
PLAN CHECK DEPOSIT
IRECI)T-75?
SEGE
,OR LIMIT IN ANY WAY THE CITY*S A51LITY TO ENFORCE
TOTAL AMOUNT DUE
'.,IERNEB,y�ACCO'�N�OEW.TL.EA��D'* THAT E READ THIS APPLICATION: THAT THE INFORMATION
APPLI ATION APPROVAL
:H
THAT AAMVTHE OWNER. OR THE DULY AUTHORIZED AGENT OF
Thl, pp,.,,- . pa —I nbI li,ld by IhO
THE OWNER. I AGnEE TO CO PLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
EMPLOYED
CALL
B. 9 011.b.1 D.P.,, .�d F... ,�..p d. n,l
TION:ANDINDOIN THEWO K AUTHORIZED THEREBY. NO PERSON WILL BE
OF WASHINGTON RELATINGTO
FOR INSPECTION
..... ...
INVIOLAT120101THELASO CODE OF THE STATE
V'O . THE L T, 00
I
W E.�S C. NSURANCE AND CW 18.27.
OAK COMPENSATION
01141AIS SIGNATURE 0 Aljb
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(425)
24"
SIGNATU7QOWNERIA�7
:7 /,,
Uri 2tk
DATE
EXT 1333
REL D BY
6.1
ATTENTION
i
-N -WIULI.U.E 'OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
IT'S
A FINAL INSPECTION IAS BEEN MADE AND APPROVAL OR A CERTIFI
11 YELLOW - INSPECTOR x
PINK - GOLD. ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SEC-�ION 109
FAX -OWNER
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