20010840.pdfDATE RECEIVED
CITY OF EDMONDS
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FOR INSPECTION
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7 1 ZIEZNATU DATE
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INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
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A FINAL
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FINAL PROJECT APPROVAL FORM
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DATE:A�Z&
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
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PERMIT
ADB#________pATE INSPECTED —
DESCRIPTION OF WORK TO BE INSPECTED —
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 Wrrrl CONDITIONS NOTED
0 Copy ofCONDMONS given to owner/contractorby fiWector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
U Copy of CORRECTION NOTICE given to owner/contractor by fiWector
2.
3.
RE-INSPECTFD OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign,
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACkS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in ...................
commercial Final
HEATING:
Test....................
--Gas.PIpIng ..........
Equipment .................
mmen�lal Final
C.�
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ...............
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
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OCCUPANCY ..................
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DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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MAILING ADDRESS
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DESCRIQE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER U.C,16WOINAL INSPECTION REO'D
VALUATION
FEE
PLAN CHECK FEE
HEAT SOURCE i GLAZING %
LOT SLOPE %
BUILDING
PLAN CHEM'
IVESTID DATE
PLUMBING
7
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t:
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GFUIDINGIFILL
Ut
DOMAIN (CURBS. SIDEWALSKESPAORRITVEEWAY , MARQUEES. ETC.) WILL REQUIRE
PERSlISSION.
-MMT-SURCHARGE
PERMITAPPLICATI N: IUD DAYS
PERMIT LIMIT: I YEAR, PROVIDED ORK IS STARTED WITHIN 180 DAYS
W
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENO. INSPECTION FEE
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
2 EDMONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAWGE or WHATEVER NATURE, ARISING DIRECTLYOR INDIRECTLY
INSPECTION FEE
RECEIPT
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT SE
PLAN CHECK DEPOSIT
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINAN E
0 NOR LIMIT IN ANY WAY TH E CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.
TOTAL AMOUNT DUE
I HE REBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION
APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
Tin. ppil,nn.— not . ",,it until signed by h,
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS FIEGULATI�G CONSTRUC
WILL BE EMPLOYED
CALL I S��Ig Ojj�.I.l r nn.ft,., CUP.,; Ind F... .. p1ld. Ind
TION, AND,IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON
CODE OF THE STATE OF WASHINGTON RELATING To
FOR INSPECTION p—PI I. .1.bwl.dl.d n.pUbU P—id.d.
I N VOLAT ON OF THE LABOR
WORKMEN S CO T 11 SURANCE AND RCW 18.27,
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oi,�tcijLs SIGNATILIRE
DATE SIGNED
0-
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A�GAT;E
(425) '
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771-02Zd RELEASED BY DATE I
EXT 13;33
ATTENTION
41)1441
IT IS UNLAWFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN WIDE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE- YELLOW - INSPE6TOR'
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX PINK - OWNER - GOLD - ASSESSOR
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