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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
DOMAIN (CURDS. SIDEWALKS, DRIVEWAY MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERM ISSION.
gAF"URCHARGE
PERMIT APPLICATION: 180DAYS
T PEFIMITIUMItIYEAS-PROVIDEO ORK IS STARTED WITHIN 100DAYS
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ENG. I,, W FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENG. INSPECTION FEE
;APPLICANT. ON BEHAI I OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
N INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
LANOSCAPIN
2 EGMONDS� WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND ADEN IS FROM ANY AND
INSPECTION FEE
ALLCLAIMS FOR DAMAGESOF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
CIIIT
'ROM THE ISSUANCE OF THIS PERMIT. ISSUANCE 01 THIS PERMIT SHALL NOT BE
EENED 10 MODIFY. WAIVE On REDUCE ANY REQUIREMENTOF ANY CITY ORDINANCE
KAN CHECK DEPOSIT In
NOR LIMIT IN ANYWAY THE CITY'S ABILITYTO ENFORCE ANYORDINANCE PROVISION.'
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TOTALAMOUN IgL
I HEREBY ACKNOW EDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
__JRECEIPT
APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
STAT ULA C
T iE OWNER. I AGREE TO COMPLY WITH CITY AND I LAWS REGULATING CONSTRUC-
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WORKMEN'S C RANCE AND PCW 18,27.
OFFICIALS EKS
SIGNA URE ((((( ER OR GENT) SIGNED
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771-10220
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ATTEP#ION
EXT 333
TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
IT IS UNLAWFUL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFt-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
ORIGINAL - FILE YELLOW - IN§PECTOR
FAX PINK - OWNER - GOLD - ASSESSOR
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FINALTROJECT APPROVAL FORM
TO:
DATE:
WMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: ----FIRE DEPARTMENT DATE—.?-- f-0 -z-
ENGINEERING DIVISION DATE —
PLANNING DIVISION DATE —
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DESCRIPTION OF WORK TO BE iNsPrcTED_.kfr,0c Acc6��7 -AcAF �7-PS7
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 BOMS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
Copy of CONDITIONS given to owner/contractor by inspector
stqr-,7-
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-2:
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RECORD OF INSPECTIONS
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SETBACKS ..................
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SPECIAL INSPECTION
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CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
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THIS PERMIT ALTHOReMS ONLY THEWORK NOTED. THIS PERMIT COVERS WORK TO
I: BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
Recording Fee
X G R
:3 OMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL EQUiRE
SEPARATEPERMISSION.
MITAPPLICATION. IN DAYS
Engr. Review
City Surcharge
—
PERMIT LIMM I YEAPR - PROW 90 WORK IS STARTED WITHIN I N DAYS
Engr. Inspection
State Surcharge
SEE BACK OF P NK PERMIT FOR MORE INFORMATION
-APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIR$. ASSIGNS AND SUCCESORS
IN INTEREST, AGREES To INDEMNIFY. DEFEND AND HOLD HARM EBB THE CITY OF
Traffic Mitigation
.
Plan Chk Deposit
EDMONDS, WASHINGTON, I'S OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE ARISING DIRECTLY OR INDIRECTLY
Fire Review
Receipt #
FROM THEISSUANCE OF THIS PERMIT, ISSUANCii OF THIS ERMIT SHALL NOT BE
Fire Inspection
Total Amount Due
9 DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OPF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CHYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION
!0
Landscapeinsp.
Receipt #
I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPUCATION; THAT THE INFORMATION
APPLICATION
APPROVAL
GIVEN IS CORRECT, AND T14AT I AM THE OWNER, OR THE DULY AUTHORIZE AGENT OF
LAT
THE OWNER. I AGREE TO COMP WITH CITY AND STATE LAWS AEGU ING CONSTRUC-
CALL
ind
'HON; AND IN DOING THE RK AUTHORI ED THEREBY, NO PERSON WILL BE EMPLOYED
V'o j'WON CODE OFZTH1 STATE OF WASHINGTON GELATIN. TO
ding Official,, 1,181her Dop,ty: and Foos all P8 'n'sn'
_Ipt Is o,k,dvIodg,d in stiono PnovIdod+
Mr. . KM�LATNTO,4' a.'1"1(R.O I NO U RA N C E AND now IQ 27.
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FOR INSPECTION
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;M14TION
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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-
OHIGINAL�FILE - YELLOW.
INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER - GOLD - ASSESSOR
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RECORD OF INSPECTIONS
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DATE APPROVED
SETBACKS ................
FOUNDATION:
Footing.................
wall..........................
Pler/Porch .................
Retaining Wall ...........
Stab Insulation ..........
PLUMBING:
4 9i
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Underground ........... .
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EXTERIOR SHEATHING
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FRAMING ..................
CA
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FIRST FLOOR FRAMING
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Wall Insulation ...........
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SHEETROCK NAILING
SPECIAL INSPECTION
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY