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THISPERMITAUTHO IZES ONLY THE WORK NOTED THIS
PERMIT COVERS WORK TO
!: BE DONE ON PRIVATE PROPERTY ONLY. ANY CO NSTRUCTION ON THE PUBLIC
a DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
GPADING�FILL
SEPARATE PERMISSION.
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P MIT APPLICATION: 100 DAYS
A, PERMIT LIMIT. I YEAR � PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG, REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
;A PLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESOnS
ENG INSPECTION FEE
N NTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAP NO
I EDMONDS. WA HINGTON, ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
AULCI-AIMS FOR DAMAGES OF WHATEVER
INSPECTION FEE
NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT ALL NOT BE
qj DEEMED TO MODIFY, WAIVE OR REDUCEANY REQUIREMENT OF ANY CITSYHOR.NAACE
PLAIN CHECK DEPOSIT
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0=1 NOR LIMITIN ANYWAYTHE CITY SABILITY TOENFORCE ANYORDINANCE PROVISION.
TOTAL AMOUNT DUE
IHEREB ACKNOWLEDGE THAT I HAVE READ THIS APPUCATMN� THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPhOVAL
T EOWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
TION AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EME OYED
CALL
T' - . '�i .'(S 'KKKI 1,'
B�I'Ig Offi-, 0.."! ... ..... IP EIld, a�d
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
WORKMEN'S COMPENSATION I URANCEANDRGWIB,27
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91GW RE DATE
SIGN E (OY'NER
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OFFICAIIS
771-0220
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- RELEASED BY KATE
ATTENTION
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IT IS UNLAWFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-02210
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGB,15i�,<LE YELLOW- INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK -OWNER - COLD ASSESSOR
$190
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: ---FIRE DEPARTMENT DATE�_
ENGINEERING DIVISION DATE— z
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A field inspection was conducted to determine rmal compliance with approved plans. Final approval
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denotes that there are no objections from the above signed Department to the release of 0 'n
PERFORMANCE BONDS and the granting of:
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES ?5
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a Copy ofCORRECTION NOTICE given to owner/contractor by inspector
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
41 SETBACKS .....................
FOUNDATION:
Footing ......................
wall.1 ........................
j PledPorch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Und erground
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
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OCCUPANCY ..................
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