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SEE BACK OF PERMITFOR OREINFORMATION
PLICANT. ON BEHALF 01 HIS OR 'HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
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I HEREBY ACKNOWLEDGE THAT I HAVE REOAD THR APPTL CE" Y.THAITRIIIF
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AND TO
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FOR INSPECTION
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IN VIOLAT ION OF THE LA504 CODE 0 HE STATE OF WASHINGTON
OFFIC AL SIGNATURE T
WORKMEN S COMPENSA"ON-Sy RANCE AND FICA IB27.
(425)
SIGNA �, WNER ENT
DATE SIGNED
/DA*
771-0220 R ASED 81
EXT 1333 ----------
ENT194 -'
OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
IT IS UNLAWFUL TO USE OR
HAS BEEN MADE AND APPROVAL OR A CERTIFk ORIGINAL FILE YELLOW INSPECTOR
GOLD -ASSESSOR
A FINAL INSPECTION
UBC SECTION 109
FAX PINK -OWNER
4—
CATE OF OCCUPANCY HAS BEEN GRANTED.
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
wall ........................
6,
PlerlPorch .................
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Retaining Wall ...........
%
fA
Slab insulation ..........
0 M
PLUMBING:
M
Underground .............
Rough -in ...................
Commercial Nnall
HEATING:
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CO
�GasTest .......... .
GasPiping .................
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Equipment .................
V ca.
Commercial Final
EXTERIOR SHEATHING
NAILING ..........................
C,
FRAMING ........................
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
Wall Insulation ...........
0
Ceiling Insulation
M'
SHEETROCK NAILING
INSPECTION
SPECIAL
MISCELLANEOUS ..........
FINAL APPROVAL FOR 1,0— 01
OCCUPANCY ..................
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NUMBER
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBILIC
GRADINGIFILL
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL 9EQUIRE
SEPARATE PERMISSION.
STATE SURCHARGE
PE MITAPPUCAnON: 1800AYS
PERMIT LIMIT.- I YEAR -PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
END, INSPECTION PEE
-APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HERS. ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
EDMONDS. WASHINGTON. ITSOFFICIALS, EMPLOYEES. AND AGENTS FROM ANYAND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIFECTLYOR INDIRECTLY
INSPECTIONFEE
RECEIPT
FA M THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
0
PLAIN CHECK DEPOSIT
DEEMED 10 MODIFY. WAIVE OR REDUCE ANY REQUIREMENTOF ANY CITY ORGINANC
I
0 N 'S ABILITY TO ENFORCE ANY OR
OR LIMIT I N ANY WAY TH E CITY
TOTAL AMOUNT DUE
Eitl_
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN ISCORRECT.A D THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
Th—PPIll 1 —1-01 nnIuntlIl,9nldbYlhl
lt�
THEOWNER. I AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING CONSTAUC-
CALL
h" 0 ,
I,Ildln II-- 'In In,y: �d F.11 ,, p1ld. and
TION: AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
OF WASHINGTON RELATING TO
FOR INSPECTION
o�oip ackno led;od In 1000 P-1 d d.
IN VIOLATION OF THE LABOR CODE OF THE STATE
WORKMEN S COMPENSATION INSURANCE AND RCW 18.27.
OFFIC L SIGNAT E
D
T) ATE SIGNED
(425)
771-0220
flAtE
R AlEGEY
EXT 1333
----------
ATTENTION
IT IS UNLAWFU L TO USE 08 OCCUPY A BUILDING, OR STRUCTUREILINTIL
77170221,.:
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK -OWNER GOLO-ASSESSOR
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