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CONSTRUCTION PERMIT APPLICATION
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PROPOSED
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FRONT UR SIDE 'EAR
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REMARKS
PROGRESS INSPECTIONS PER USC 1081FINAL INSPECTION REO'l
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MECHANICAL
THIS PERMIT AUTHO DES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY� ANY CONSTRUCTION ON THE PUBLIC
GRA, INGIFILL
. DOMAIN [CURBS� SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
SURCHARGE
PERMIT APPLICATIO � 110OAYS
T PERMIT LIMTT� 1 YEAR . PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG, REVIE. FEES
SEE SACK OF PINK PERMIT FOR MORE INFORMATION
N BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
ENG, INSPECTION
�ARPUCANT.
N NITEREST, AGREES TO INDEMNIFY. DEPEND AND HOLD HARMLESS THE CITY OF
LANDSCAP NO
2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
FEE
A L CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
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x FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE
DEENLiEDITT=FY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
PLAN CHECK DEPOSIT
IN
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NOR IM WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVIS10-
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IFT
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HEFIBB ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNEH� OR THE DULY AUTHORIZED AGENT OF
T EOWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
1 G pl,llt 11ped by fhl
TION AND IN DOING THE WORK AUTHORIZED THEO E BY, NO PERSON WILL BE EM PLOY ED
VIOLATION 01 THE LA80R CODE 01 1"l STATE 01 WASHINGTON RELATING TO
FOR INSPECTION
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WORKNEN'S COMPENSATION INSURANCE AND RCW 18.27,
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OFrlTIALSSIONAl.FE DATE
D�SIGNED
(425)
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771-0220
Jk LAMIA
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RELEA Y DATE
ATTIEENTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING 08 STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
1/ ORIGINAL FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER GOLD - ASSESSOR
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TINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: ___YlRE DEPARTMENT DATE 2- 0 —01
ERING DIVISION DATE—
P LANNING DIVISION DATE�_
PROJECT_14,:2�,,Iak,�-
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PERMIT �Lool-CIPLI_6 ADB#-------PATE INSPECTED-6 --LO _-0 2-
DESCRIPTION OF WORK TO BE INSPECTED_J�'
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 BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
a Copy of CONDITIONS. given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
a Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign_
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS ................
FOUNDATION:
Footing ......................
Wall ...............
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Pier/Porch .................
Retaining Wall ...........
0
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Slab Insulation
PLUMBING:
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0
Underground .............
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Rough
-in ...................
Commercial Final
C
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HEATING:
10-4
Gas Test ....................
Gas Piping .. ...........
Equipment .................
0 n
Commercial Final
171 M
EXTERIOR SHEATHING
0
0
NAILING ..........................
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FRAMING ........................
Q 0
FIRST FLOOR FRAMING...
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INSULATION ...................
Floor Insulation
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Wall Insulation ..........
Ceiling Insulation
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SHEETROCK NAILING
0
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SPECIAL INSPECTION
MISCELLANEOUS
FINAL APPROVAL FOR
OCCUPANCY ...............