20020027.pdfEPERMIT EXPIRES
CITY OF EDMONDS
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P RMIT
NUMBER
CONSTRUCTION PERMIT APPLICATION
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REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'l
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VALUATION
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BUILDING
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IWORK
PLAN CHECK NO: TED DATE
PLUMBING
—NIC L
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS TO
BE DONE ON PRIVATE P OPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVE , MARQUEES, ETC.) WILL REQUIRE
WAYS
RADING'FILL
SEPARATE PERIM ISSION.
RE MIT APPLICATION: 180 DAYS
PERMIT LIMIT, I YEAR - PROVIDED WORK IS STARTED WITHIN 160 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
PLICANT ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
�A
N NTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAP NG
2 EDMONDS, WASHINGTON ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
INSPECTION FEE
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
RECEIPT
F OM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEM D TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT Or ANY CITY ORDINANCE
PLAN CHECK DEPOSIT
NOR I IMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
TOTAL AMOUNT DUE
JRIECEH7
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
T EOWNGA I AGREE TO COMPLY WITH Cl Y AND STATE LAWS REGULATING CON$TRUC-
TION. AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
CALL
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IN VK`L'T LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION 11—pi 11 .—Illodgo— p ...
WoRKNIE��MFTIN'kA`Tll N IN URANCE AND PCW 18,27,
OFFICIALS SIGNATURE DATE
SIGNATU E IQWN ' 0 AGENT)
(425)
-Z-7
771-022 n
RELEk S _E Y
ATTENTION J
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-
ORIGINAL - FILE - YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109
FAX
PINK -OWNER - GOLD, ASSESSOR
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: ���.�FIRE DEPARTMENT DATE
ENGINEERING DIVISION DATE —
PLANNING DIVISION DATE--
PROJECT-04:L�L-��t7�� a6& &A-1—
SITE ADDRESS
PERMr r # lk-XI 00 ADB#___--PATE INSPECTED� . .. ... .....
DESCRIPTION OF WORK TO BE INSPECTEDJLr—ff—&,!L,��- C�z
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
a Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE-INSpECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date. Sign_
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Coiling Insulation
SHEETTIOCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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