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PERMIT EXPIRES
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PROGRESS INSPECTIONS PER USC 1001FINAL INSPECTION RFO`D,
Description
FEE
Description
FEE
Plan Check
HEAT SOURCE OWING LOT SLOPE I
Building
PLAN CHFCK NO: "STE. 1111
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DOMAIN JCURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, M.) WILL REQUIRE
SEPARATE PERMISSION.
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15 PER TrAPPLICATION: 184DAYS
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City Surcharge
A. PERMIT UMM. I YEAR - PROVIDED WORK IS STARTED WITHIN 10 DAYS
gi; inspection
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State Surcharge
SEE BACK OF PINK PERMIT MR MORE INFORMATION
4ANDFire
'APPLICANII. ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
Traffic Mitigation
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Plan Chk Deposit
IN INTEREST, AGREES To INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Review
Receipt #
FROM THE I SUANCE OF THIS PEAMff. ISSUANCE F THIS PERMIT SHALL NOT HE
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D SAVED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF MY CITY ORDINANCE
Fire Inspection
TotalAmountDue
21 N6R LIMIT IN ANY WAY THE CITY$ ABILITY 10 ENFORCE ANY ORDINANCE PROVISION.-
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Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVEN IS CORRECT, AND TRATi Am THE OWNER. OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAW REGULArING CONSTRUC.
CALL
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TION.'AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING 70
FOR INSPECTION
a,, ding 01fillat or hisihar Deputy: ald Fees am paid, sed
mc.111 is,elnoadadged In space p(mided.
WORKMEN'S COMPENSATIOtjpikRANCE AND RCW 1&27�
OF C ONATURE DATE
SIG (OWNER ADEN DATE SIGNED
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771 "0220
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RELEIV-D BY DATE
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IT IS UNLAWFUL TO USE '.1-- IPYAj_ DING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIF(-
ORIGINAL - FILE YELLOW -INSPECTOR
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
FROM: IRE DEPARTMENTDATE-�—
ENGINEERING DIVISION DATE
PLANNING DIVISION DATE
PROJECT Z HE20,9 YLJ-2 �e�Zc
SITE ADDRESS
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DESCRIPTION OF, WORK TO BE INSPECTED-4:f �C- �C
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/contractorby inspector
2.
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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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
a Copy of CONDITIONS given to owner/contractor by inspector
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
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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
OCCUPANCY ..................
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
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Retaining Wall ...........
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OCCUPANCY