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CITY OF EDMONDS
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STATE SURCHARGE
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT, I YEAR - PROVIDED WORK 11 STARTED WITHIN III DAYS
6NQ REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
END, INSPECTION FEE
;APPLICANT
w N NTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
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2 EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANYAND
INSPECTION FEE
ALLCLAIMSFOR DAMAGES OF WHATEVER NATURE, ARISING DIRECT LYOR INDIRECTLY
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c D"EMEDTOMODIFY, WAIVE OR REDUCE ANY REOUtREMENTOF AFIY CITY ORDINANCE
PLAN CHECK DEPOSIT
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TOTAL AMOUNT DUE
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I HERED ACKNOWLEDGE THAT I HAVE READ I HIS APPLICATION. THAT THE INFORMATION
APPLIC�ATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DUI-Y AUTHORIZED AGENT OF
THEOWNER TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
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771-0220
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RELEASED BY I IDATE
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL,FJU! - YSILLOW�16PECIoR
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109
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INAL PROJECT APPROVAL FQRM
TO:_
DATE:-
MEmo To: PERmrr COORDINATOR, BUffDING DIVISION
FROM: FIRE DEPARTMENT DATE -
ENGINEERING DIVISION DATE-
PLAI 4NING DIVISION DATE
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SITE ADDRESS
PERMIT # ADB#_Z�z , i �&o DATE 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 WITH CONDITIONS NOTED
o Copy of CONDITIONS given to owner/contractor by inspector
I
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- Sip�
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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:,
Gas Test ...............
Gas Piping .................
Equiprnent,:; ...............
Commercial Final
EXTERIOR SHEATHING.
NAILING ..........................
7
FRAMING ........................
FIRST FLOOR FRAMING
INSULATION ...............
Floor Insulation
Wall Insulation . ..........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY
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