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CITY OF EDMONDS
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PERMIT
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CONSTRUCTION PERMIT APPLICATION
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REMARKS
INSPECTIONS PER USC 108/FINAL INSPECTION RECIl
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
140
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC�) WILL AEQUIAE
SEPARATE PERMISSION.
STATE SURCHARGE
RE MIT AF11MATION; 160 DAYS
PERMIT LIMIT,. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
END INSPECTION PEE
'A PLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIPS. ASSIGNS AND SUCCESoRS
w IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS HE CITY 01
%ii EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FRO. 'NY AND
ALLCLAIMSFORDAMAGES F WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM T14E ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
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_I DEEMEDT MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CIT ORDINANCE
0 NOR LIMIT IN ANY WAY THE. CITY�S ABILITY TO ENFORCE ANY ORDINANCE PROVISION,
RECEIPT
TOTAL AMOUNT DUE
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1 F EREBY ACKNOWLEDGE THAl I HAVE REA THIS APPLICATION THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER, 08 THE DULY AUTHORIZED AGENT OF
T:IE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
T ON, AND IN DO NG THE WORK AUTHORIZED THEREBY, NO RE RSON WILL BE EMPLOY ED
I N VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
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WORKMEN'S COMPENSATION INSURANCE AND ACW 16.27,
DATE
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11/12/0e
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771-0220
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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. UBC SECTION 109
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FINAL PROJECT APPROVAL FORM
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MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
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ENGINEERING DIVISION DAT1131 1 ZA 03
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A field inspection was conducted to determine final compliance with approved plans. Final approval
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS
FOUNDATION:
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INSULATION .................
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Floor Insulation
Wall Insulation ...........
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Ceiling Insulation
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SHEETROCK NAILING
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SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR 2-03
OCCUPANCY ..........
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