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Engr. Review
City Surcharge
PERMRAPPLICATION: VIDDAYS
PERMIT LR�IrB I YEAR. PROVR)EC` WORKISST&FITE-VITTHIN INDAYS
Engf. Inspection
S 10 SLIrcharge
SEE BACK OF PINK PERMIT FOR MORE INFORKATION
Plan Chk Deposit
—11oANT ON IEHAILF OFINHIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
To GEMNIFY. DEFEND AND HOLD HMMLE SS THE CITY OF
Traffic Mitigation
Receipt #
IN INTEREST, AGREES
EDMONDS. WMHINGTON� ITS OFFICIALS. EMPLOYEES, AND AGENTS MOM ANY AND
Fire Review
ALL CLAIMS FOR DAMAGES OF WHArEVER W URE, ARISING DIRECTLY OR INDIRECTLY
MoM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Fire Inspection
TotalAmount u
DEEMED TO MODI"' WAIVE OR REDUCE My RECIUIREMEW OF ANY CITY ORDINANCE
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NOR UMff IN ANrY WAY THE CITYS ABR11rY TO ENFORCE ANY ORDINANCE PROVISION.
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Recelpt# A 11
7;ii;�WLEDGE THAT HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT AM THE OMER. OR THE DUVf AUTHORIZED AGENT OF
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TN..PP1I.LI1rp
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC,
WILL BE EMPLOYED
CALL
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B.ild.g Offl,I&I or �klsfl.00
TIGN; AND IN DOING THE IN RK AUTHORIZED THEREBY. NO PERSON
CODE OF THE STATE OF WASHINGTON RELATING TO
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FOR INSPECTION Ip" n Q21Pv-P0,1.d
IN VIOLATION OF THE LABOR
WoRKMENS COMPENSATI RM 11127.
OFFICIAL RE DATE
(425)
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(OWN DATE SIGNED
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, DATE
771-0220
RE EA
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AWENTION
EXT 1333
08 STRUCTURE UNTIL
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI.
oRIGINAL-FILE YEUL0w-INsPECToR
HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK-OWNrR GOLD -ASSESSOR
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FINAL . PROJECT APPROVAL FORM
TO: —
DATE:
M[EMO TO: PERX[IT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE-�:L--:-
ENGINEERING DIVISION DATE —
PLANNING DIVISION DATE—
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PERMIT #2,_a�-�L_ADB#______pATE INSPECTED-����
DESCRIPTION OF WORK TO BE INSPECTE —L-e6
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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
PERFO E BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WIT11 CONDITIONS NOTED
u Copy ofCONDITIONS given to owner/contrautorby inspector
1.
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— Sigo—
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS'.. ...................
FOUNDATION:
0o6tingi . ......................
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Pier/Porch .................
Retaining Wall ..........
Step Insuialtion ..........
PLUMBING:
nderground ..............
Rough -In ...................
Commercial Final
HEATING:
Gas Test ...................
Gas Piping ..................
Equipment ..........
Commercial Final
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ...............
FIRST FLOOR FRAMING
INSULATION ................... .
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ...............
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REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUI)RAul-GE
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GIAZING LOT SLOPE
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PLAN Cli 060; wen. DATE
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C"" THE "'BUR "O"B"S . To
NWW=U= GO 'n" Pu"UC
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. Mrr ) viti.L. REQUIRE
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FIESSESSIOUL
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—
VIUMT. MBOVIGIED WORK It $YAMD
Engr. inspection
US RUX OF POST pamm FOR MGM MWONMT*"
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gm AND succesoks
Traffic Mitigation
IN INTIRSEST. AQUI TO LNIDEMNIFY. DEFEND AND HOLD KAIULFS3 THE CITf OF
E-Aa—ENTS FRID. AN`V AND
=CTLY
Fire Review
ALI, CLIUMBI FO US 11 *4ATEVER NATURE, ARISING DIAJI OR
MIDE, THE "UAWA OF The "Pisr ISSUANCE OF INS PERt&r SHALL NOT BE
Fife Inspection
DEEMED TO MODIFY, VI Oft IMOUDE ANY REQUIREMENT OF ATR` CITY ORDINANCE
Noll LIMIT W ANY WAY Mtl CnY8 ABILITY 10 ENFORCE ANY ORM*kaQW=A PACIAW ON.-
Landscrapainsp..
I KAREN ACKNOWLEDGE THAT � HAVE READ THIS APP, iCATION, THAT THE INFORMATION
, GSIEN a COMXCT. AND THAT AM THE aNMFL OR THE GULY AUTHOPILZED AGENT OF
THIS OWNER. I AMU TO COMPLY WITH CITY AND STATE LAM REGULATING CONSTI
CALL
TIOK AM IN DOWD THE WORK ^MiMnD TITI,,gy. NO PERSON 1� BE EMPLOYED
IN VIOLATION OF THE LABOR CODE Of THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
WOFAUAE" COUPE AM ACW 15,17.
OF
DATE "a
$!=(OWNFA AGENT) NED
(425)
1-3-C-11
-0220
771 HE
Ar%NTioN
EXT 1333
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-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBG SECTION 109
FAX
INSPECTION
Recording Fee
City Surcharge
stal. Sur.h.,go
_�I;m hk D.10-11
Receipt III
Total Amount Du� e
Receipt #
IPPLICATION APPROVAL
appiims�n is na a Penh � sig,—I by th,
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VIURE
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