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CONSTRUCTION PERMIT APPLICATION JOB SUITEIAPT#
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THIS PERMIT AUTHORRES ONLYTHE WORK NOTED. THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY. AM CONSTRUCTION ON THE PUDUC
Grading
Recording Fee
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION,
a—
Engr. Review
City Surcharge 15—
PE MIT APPLICATION: 1. DAYS
PERMIT UMM I YFAR-PROVID 0 WORK IS STARTED WITHIN INDAYS
Engr. Inspection
State Surcharge
SEE BACK OF PINK PERMIT FOR MORE INFORM - ATION
Plan Chk Deposit -12
'APPLICANT, ON BEHAL OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCCSORS
Traffic Mitigation
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IN INTEREST, AGREES 10 INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EMPLOYEES, M11 FROM ANY AND
—
Fire Review
Receipt # I
EDMONDS, WASHINGTON, ITS OFFIC1,111, AGENTS
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMft ISSUANCE OF T141S PERMIT SHALL NOT BE
'HALL No I "
Total Amount Due
IT' RORIANCE
ANY C 0
DEEMED TO MOD'FX WAIVE R REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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Fire Inspection
o NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE MY ORDINANCE PROVISION,'
I CE OV"'ON '
AID NAN PR
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Receipt #
I R.AT'.N
I HEREBY ACKNOWLEOG THAT HAVE READ THIS APPLICATION: THAT THE INFORMATION
I GENT OF
GIVEN is CORRECT. AND THAT AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
it ONSTRUC
THE OWNER. I AGREE To COMPLY Valli CITY AND STATE LAWS FIEGULATING CONSTRUC-
CALL
This rIppIrIAIIIII is hot a prinnit ranal rinnid by Me
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EMP
AUTHORIZED THEREBY. NO PERSON WILL BE WYED
T'ON To R , T, G '.
1. OF THE STATE .1 WASHINGTON EIA-IN. 1.
FOR INSPECTION
F
Said nq Offlaird or his/her Deputy; and Fees are paid, and
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CE AND RCW 18 27 _
OFF411. S 619NAT E A
E�n DATE SIGNED
(425)��ER
771-0220
DATE
XfTENTIOW"
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE YELLOW :INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANT�D. UBC SECTION 109
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TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
'FROM: FIRE DEPARTMENT DATE
ENGINEERING DIVISION DATE
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PROJECT�— FIJI MARKe� �,l C
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PERMIT# 242/—�-QWO ADB#2.001-9-11,j)ATEINSPECTE D-- 1 0 2- -
DESCRIPTION OF WORK TO BE INSPECTED ��,JC, t,4
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A field inspection was conducted to determine flual compliance with approved plans. Final approval
denotes: that there are no objections from the above signed Department to the release of
LERFORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL wrrH CONDITIONS NOTED
u Copy of CONDITIONS given to owner/contractorby inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
a Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS ....................
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FOUNDATION:
Footing .................
Wall ..................
Pier/Porch .................
Retaining Wall
Slab Insulation ..........
PLUMBING:
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Underground .............
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Rough -in ................
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Commercial Final
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HEATING:
Gas Test .....................
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Gas Piping .................
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Equipment
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EXTERIOR SHEATHING
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NAILING ............
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FRAMING ......................
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FIRST FLOOR FRAMING
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INSULATION ...................
Floor Insulation
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Wall Insulation
Ceiling Insulation
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SHEETROCK NAILING
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SPECIAL INSPECTION
MISCELLANEOUS
FINAL APPROVAL FOR
OCCUPANCY ................