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USE PERMIT
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CODE OCCUPANT
GROUP
NUMBER Vi
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LOAD
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION RE 'D
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VALUATION
FEE
PLAN CHECK FEE
HEAT SOURCE GI-AZING
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BUILDING
PLAN CM NOt
ESTEO DATE
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PLUMBING
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PE RMIT COVERS WORK TO
L BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLI
GRADINGIFILL
2
DOMAIN (CURBS. S. MARQUEES, ETC.) WILL REQUIRE
SIDEWALKS, DRIVEWAY
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-ST�TMURCHARGE
PERMIT APPLICATI N: 10 DAYS
2
0
PERMIT LIMIT: I YEAR - PROVIDED W FIX IS STARTED WITHIN 180 PAYS
ENO, REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS� A SIGNS AND SUCCESORS
ENG. INSPECTION FEE
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
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INDIRECTLY
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ALLCLA. Fo DANIAGE�,O ATEVER NATURE.'ARISING DIRECTLYOR
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
RECE WAT
D EEMEDT MODIFY. WAIVE OR REDU E ANY REOUIREMENTOF ANY CITY ORDINANCE
E PROVISION -
ANYORDINANCE
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NOR Ll MIT ION ANY WAYTHE CRY'S A.ICLITY TO ENFORCE
TOTAL AMOUNT DUE
PHERED ACKNOWLEDGETHAT AVEREAO AT THAT THE INFORMATION
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ON�
DUI
APPLICATIO APPROVAL
GIVEN IS CORRECT: AND THAT; AM THE OW T"E.' Ap.oT.`E AUTHORIZED AGENT OF
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THE OWNER I AGRE PLY WITH CITY AND STATE LAWS REGULATING
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FOR INSPECTION
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IN VIOLATION OF THE LABOR CODE OF THE STATE
WORKMEN S COMPENSATION INSURANCE AND FICW 18 27.
O`JIALS SIGNATURE AlE
11 111E _FGATE
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SIGNED
(425)
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771- 0220
LE 5 D By MATE
EXT 1333
4trENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221 1
HAS BEEN MADE AND APPROVAL OR A CERTiFl- ORIGINAL —LE YELLOW -INSPECTOR
A FINAL INSPECTION
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX PINK - OWNER GOLD - ASSESSOR
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MNAL PROJECT APPROVAL FORM
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DATE:
NIEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: C FIRE DEPARTNIENT DATE_T__1_e___6'L_
ENGINEERING DIVISION DATE -
PLANNING DIVISION DATE -
PRO CT
SITE ADDRESS
PERmrr #_,,-_Lz! - Oa (e 7 B#________PATEINSPECTED,
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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 granting of:
___,�/_Final approval ofthe described work
GRANT FINAL PROJECT APPROVAL
__._GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
-FAILED FINAL INSPECTION - OUTSTANDING ISSUES
1. .
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 .................
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Retalnlng Wall
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in ...................
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Commercial Final . .....
HEATING:
IT1
Gas Test ....................
ID i
GasPiping .................
Equipment ;..; .............
Commercial Final
EXTERIOR SHEATHING
NAILING .................
(0)
FRAMING
FIRST FLOOR FRAMING...
INSULATION ...................
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Floor insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
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SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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AT -E-E-E. rpiRd Expizs�
CITY OF EDMONDS
PERM I
IN U M.ER AMI - 416,6 ---3
CONSTRUCTION PERMIT APPLICATION
JOB SUITEIAPTO
ADDRESS 41 t �'d
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PLAT NAMEISUBDIVISION NO.
LOT NO.
LIDNO.
LID FEE $
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REMARKS
OWNERCONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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FIRE REVIEWED BY DATE
CITY
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TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE�
VARIANCE OR CU
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INSPECTION
RE 'D
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;ROPERTY TAX ACCOUNT PARCEL b
SERA REVIEW
COMPLETE I EXEMPT
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SIGN AREA
ALLOWED , PROPOSED
HEIGHT
ALLOWED , PROPOSED
0 NEW 0 PLUMBING / MECH
LOT COVE AGE
ALLIED PROPOSED
REQUIRED SETBACKS (Fr.)
FRONT SIDE REAR
PROPOSED SETBACKS I T)
FRONT UPSIDE REAFR
ADDIT10N ci C MPLIANCEOR
CHANGE OF USE
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REMA KS
RFSS INSPECTIONS PER UBC 108/FINAL INSPECTION
VALUATION I , FEE
PLAIN CHECK FEE
HEAT SOURCE .-VN.
LOT .-F.
BUILDING
PLAN :MNO
111STED DATE
PLUMBING
tGRADINGIFILL
MECHANICAL
THIS PERMIT AUTHORIZES ..- THE WORK ..T— IrHIS PERMIT COVERS WO RK TO
BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURDS. SIDEWALKS, DRIVE I WAYS, MARQUEES, ETC.) WILL REQUIRE
%SEPARATE PERMISSION.
.
MlArE SURCHARGE
PiRMITAPPUCATIOH: I 600AYIS
PERMIT LIMIT. I YEAR - PROVID 0 WORK IS STARTED WITHIN 1 80 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENO. REVIEW FEES
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
ENO. INSPECTION FEE
IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS.WA HINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANYAND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FR M THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
NY Y
DEEMED TO MODIFY, WAIVE OR REDUCE ANY RSQUIREMENTOFA CIT ORDINANCE
LANDSCAPING
INSPECTION FE E
PLAN CHECK DEPOSIT
4'cE7
-2—
0 NYORDINANCE PROVISION.-
ml NORLIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE A
TOTAL AMOUNr DUE jllClIPT
IHERE 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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC"
TION AND IN DOING TH E WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
CALL
APPLICATION APPROVAL
T'I, ppk,bll 1, 101 . p1mil dMil lig,ld by Ihl
B dilg Offbilt I hi�Gl Doolty: Ild Fees all plid. ,d
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Ipt il 11-111do,d 1, p— p,.WdW.
WORKMEN'S COMPENSATI?N INSURANCE AND ROW 18.21.
(425)
2ALS SIGHATURE
st YRE(OWNERO WGE
IGNED
14ZA
1-01 j
771-0220
RtLEASIEDBY DATE
i�FtENTION EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221 1
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGUNAL-FILE YELLOW -INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK - OWNER GOLD - ASSESSOR
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