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CITY OF EDMONDS
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REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
VALUATION
FEE
PLAN CHECK FEE
HEAT SOURCE LOT SLOPE % BUILDING 31-
PLAN CHE77' JVESATEIOATE
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
tz BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC GRA INGOFILL
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DOMAIN (CURBS, SIDEWALKS. DRIVE AYS. MAROUEES. ETC.) WILL BE RE
SEPARATE PERMISSION. S%RC.�F.E
PE.MITAPPLICATI N! ISO DAYS Jo
WITHIN 180 DAYS
PERMIT LIMIT. I YEAR . PROVIDED WORK IS STARTED ENG, REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
END INSPECTION FEE
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESO-S
IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
DMONDS, WASHINGTO 'I, I S OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
LIECLMMSFO DA A ZS F WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY J110EIPT
NOT BE
S PERMIT. ISSUANCE 01 THIS PERMIT SHALL P
FROM THE ISS ANCE OF TH LAN CHECK DEPOSIT
I. DEEMED TO MODIFY.WAIVE OR REDUCEANI REQUIREMENT OF ANY CITY ORDINANCE
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0 NORLIMIT IN ANY WAYTHE CITY SABILITYTO ENFORCE ANY ORDINANCE PROVISIONom 'OT
= TOTAL AMOUNT DUE TE
I HEREBY ACKNOWLEDGE THAT: HAVE READ THIS APPLICATION. THAT THE INFORMATION APPROVAL
GIVEN IS CORRECT. AND THAT AM THE OWNER. OR THE DULY AUTHORIZED AGENT 01 tPPLICATION
CONSTRUC I,- I .,.,g III
THEOWNER I AGREE TO CO-PLYWITH Cl Y AND STATE LAWS REGULATING CALL S�..O DOPUIV, - Fo.,
THEREBY. NO PERSON WILL BE 'ho'
TION. AND IN DOING THE WORK AUTHORIZED Idg— 1p- pl-Sad
OF THE LABOR CODE OF THE STAT E 0 F WASHINGTON RELEAVPI'�OGYIFO FOR INSPECTION I.-pt 1� --
IN VIOLATION
WORKMEN S COMPENSATION INSURANCE AND RCW 10 27
G;FL�AIURE
SIGNA IOWNE. 77ATE SIgNIED (425)
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1-:57111 /411 771-0220
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IT IS UNLAWFUL TO USE 08 OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
HAS BEEN MADE AND APPROVAL OR A CERTIFI-
A FINAL INSPECTION
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK - OWNER COLD - ASSESSOR
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FINAL PROJECT APPROVAL FORM
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DATE:44�?�
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: -FIRE DEPARTMENT DATE -
ENGINEERING DIVISION DATE -
PLANNING DIVISION DATELD--
PROJECT
SITE ADDRESL��
PERMIT #_"L- �7�ADB#----AATE INSPECTED -
DESCRIPTION OF WORK TO BE IRNSPECTE
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
MONS NOTED
-GRANT PROJECT APPROVAL WITH COND
FINAL INSPECTION OUTSTANDING ISSUES
2.
3.
-RE-INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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RECORD OF INSP ECTIONS
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DATE APPROVED
SETBAC KS .....................
FOUNDATION:
Footing ......................
wall..........................
PlertPorch .................
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Retaining Wall ...........
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Slaii insulation ..........
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PLUMBING:
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Underground.............
Rough -in ...................
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Gas Test ....................
Gas Piping .................
Equipment .................
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EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
Wall insulation ...........
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Ceiling Insulation
0
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SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
-07�3v/
DATE RECEIVE
RES =Y::�LE
CITY OF EDMONDS Z ME AV -e 7
CONSTRUCTION PERMIT APPLICATION JOB SUITVAPT,
ADDRESS
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ADDITION COMMERCIAL o COMPLIANCEOR
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0 REMODEL, APARTMENT SIGN
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THIS PERMIT AUTHORIZES ONLY THE IlIf.Rk NOTED. THIS PERMIT COVERS WORK Tl(
1110"11" PRIVATE PROPERTY ONLY. ANY CONSTRUCTION N THE PUBLIC
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, Elp'WILLREQUIRE,
SEPARATE PERMISSION.
PERMIT APPLicxnom: 'so DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
APPLICANT ON BEHALF OF HIS OR HE� Spo SE,HEIRS, ASSIGNS AND SUPCESOR
lbl.INTEREST. AGREES TOJNDEMmFY. DEF5 AND HO� 0 ARMLESS THE CITY 0
'DMONDlj;AT"TN Ts OFFICIALS. EMEYEES. ANDHAGENTS FROM ANY AN
LLCLA'. DA..EiGF WHATEVER MATURE. ARISING DIRECTLYOR INDIRECTLY
E A �Ro E OF THIS PERMIT. ISSUANCE OF TH P RMIT SHALL NOT B
IS e
WAIVE OR REDUCE ANY AEOUIREMENTOF ANY CITY OADINANC
T N DIVISION LOT NO
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YES 13 NO 0 9
YES NO 0
5
REMARKS
KOWNENCONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ENGINEERING EV.EWE..ATE
FIRE REVIEWED By DATE
r
VARIANCE OR CU
SHORELINE OR ADBO
_70
INSPECTI N
BOND
POSTED
4R,Q'D
YES E3ND
BEIRA lElIEW
COMPLETE EXEMPT
SIGN AREA
ALLOWED PROPOSE D
ALLOWED I PROPOSED
EXP
16's
LOTCOVERAGE
REQUIRED SETBACKS (FT.1
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
IONT SIDE REAR
FRONT URSIDE REAR
Ira
PARKING
LOT AREA
PLAnI . FE�l
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RECEIPT
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—HE CITY'S ABILITY TO ENFORCE AMY ORDINANCE PROVISION.'
TOTAL AMOUNT DUE
R
EDGE THAT I HAVE READ THIS APPLICATION: THAI THE IRPOSMATION
APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHOAIZEQ AGENT
LAWS REGULATING CONSTRUC
OF
CALL
F — I.W.
WVJNER I AGREE TO COMPLY WITH CITY AND STATE
THEREBY. No PERSON WILL BE EMPLOYED
0"..,
11 1,— P—dod.
�AND 00 NO THE WORK AUTHORIZED
IN I E
CODE OF THE STAT OF WASHINGTON AELATINC TO
FOR INSPECTION
.... .. . gld
IN VIOLATION OF THE LABOR
WORKMENE COMPENSATION INSURANCE AND RCW 18,27,
OFFI IALS SIGNATURE T
,GN A=
DATEnD
1 (425)
771-0220
DATE
REL E BY
',��eNTION
EXT 333
LN4
IT IS UNLAWFULTO USE OR OCCUPY A BUILDING 08 STRUCTURE UNTIL
771 -0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL 09 A CERTIFI.
ORIGINAL -FILE - YELLCW-INSWCTC(R
OR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK -OWNER - GOLD-ASSESk
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