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SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENG. REVIEW FEES
ENG. INSPECTION FEE
-APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. EIRS. A SIGNS AND SUCCESOAS
A S ' CITY OF
IN INTEREST. AGREES TO INDEMNIFY. DEFEND ANU HOLD HARMLES
USCAVING
EDMONDS.WASHINGTON. ITSOFRCIALS. EMPLOYEES. AND AGEN TS FROM ANY AND
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HECEIPT
I HEREBY ACKNOWLEDGE TH - AVE READ THIS APPLICATION. THAT THE IN' NATION
HAIA
APPLICATION APPROVAL
AGENT OF
AT� THE OWNER. OR THE DULY AUTHORIZEDo
GIVEN IS CORRECT. AND THAT
ThIl Ippil"ll— 11 q .1 I.g-d by
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01 WASHINGTON RELATING TO
FOR INSPECTION .Pl. lldg IF —
IN VIOLATION OF THE LABOR CODE OF HE STATE
WORKMEN S��SATWN INSURANCE AND RCW 18 21.
OFFICIALS KI TU E DATE
SIGNED
(425)
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9 -;2? 01
DATE
771-0220
RELEASED Y
-ATTENTION
EXT 333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI
ORIGINAL I YELLOW - NSPEC OR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK.OWNER GOLD -ASSESS
. . . .... ...
RECORD OF INSPECTIONS
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ................
Pier/Porch .................
Retainlrig Wall ...........
Slab Insulation ..........
PLUMBING:
undergrqt�nd .............
.... . ........
HEATING:
aa
Gas Test ............
Gas:PIpIng ...........
_Equipment ... . ..............
Comm ercial Final
E)(TERIOR SHEATHING
NAILING...........................
FRAMING ........................
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
i
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
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OCCUPANCY ..................
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PLAN CHECK NO: VESTED DATE PLUMBING
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'EDONE ON PRIVATE PROPERTY ONLY .1 C,..STRUCTION ON THE PUBLIC GRADINGIFILL
DOMAIN 'D .. S. SIDEWALKS. DRIVEWAYS. MARQUEES. ET - C.) WILL REQUIRE I
SEPARATE PEAMISS ON. ;AW<RC.ARGE
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PERMITAPPUCATION 10DAY5
T LIMIT: I YEAR - P..VGEG WORK,. _ARTEG WrTHIN ISO DAYS ENG. REVIEW FEES
PERMI SEE BACK OF PINK PERMIT FOR MOREN�.PMATHDN
;APPUE1�AE1S1jQA1.1EHAIFT 0 F I I EM.R, H E R SPOU SE. H El R S. A SSIGN S EASNSD SU CC E SORE ENG. INSPECTION FEE
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N I' CIALS EMPLOYEES AN TS FROM ANYAND
EDMONDS. WASHINGTON. ITS OFFI G=L
ALLCLAIMSFORDAMAGESOF.W=VE4 NATURE. ARIiING DIRECTLYOR INDIRECTLY
FR M THE ISSUANCE OF THI IT ISSUANCE OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT
DEOEMED TO MODIFY. WAIVEOR REDUCE ANY REQUIREIAENTOF ANY CITY ORDINANC�
0 NOR LIMIT IN ANY WAYTHE CITY'S ABILITY To ENFORCE ANYORDINANCE PROVISION
TOTAL AMOUNT DUE
RECEIPT
A EIPT
I HEREBY ACKNOWLEDGE THAT -HAVE READ T.IS APPLICATION: THATTHEINFOR-TION
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OA;H, DU�L, AUTHOA,�IID AGENT OF
THE GWNER� I AGREE TO COMPLY WITH CITY AND ST 'LAW RE.U, .C..STRUC- CALL
TION No GIN BY. No PERSON WILL BE EMPLOYED
VI.AND G THE WORK AUTHORIZED THERE WASHINGTON RELATING TO F OCR INSPECTION
IN DILATION OF THE LABOR CODE OF THE STATE OF
AND RCW IS 27
APPLICATION APPROVAL
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FriCIALS GNATU DATE
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WORKMEN S CC��NSATIONI INSURA 0
=&A AD E SIGNED (425)
:2 '? 771-0220 REL AS DATE
ATTENTION EXT 333
ITIS UNLAWFULTO USEOR OCCUPY ABUILDING OR STRUCTURE UNTIL 771-0221 FILE YELLOW I SPEC A
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL
CATE OF 0 UPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK 0 LR GOLD - ASSESSOR
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