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PERMIT EXPIRE
CITY OF EDMONDS
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REMARKS
PROGRESS INSPECTIONS PER LIBC 108/FINAL INSPECTION REQ'I
VALUATION I FEE
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. TH IS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
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DOMAIN ICURBS, SIDEWALKS, DRIVEWAYS, MAROUEES, ETC�� WILL REGUIRE
SEPARATE PERMISSION.
STATES SURqHAFGE
PERMIT APPLICATION; HIS DAYS
PERMIT LIMIT� 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-APR ICANT ON BEHALF OF HIS OR HER $ROUSE . HEIRS, ASSIGNS AND SUCCESORS
T ON FEE
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, IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD "ARMLESS THE CITY OF
rLANDSCAPING
2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS 'ROM ANYAND
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INSPECTION FEE
ALL CLAIMS FOR DAMAGES 05 WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FIT M THE ISSUANCE 01 THIS PERMIT, ISSUANCE OF THIS BRIM ALL NOT BE
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PLAN CHECK DEPOSIT
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DEEMEDTOMODIFY. WAIVE OR REDUCEANY REQUIREMENT OF CITY ORDINANCE
0 NOR LIMIT IN ANYWAYTHE CITWS ABILITY TO ENFORCE ANY ORDINANCE PROVSION.�
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RECE
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TO IAL AMOUNT DUE
NEGEB ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN ISCORRECT.ANDT AT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
T EOWNER I AGREE 10 COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
CALL
TION, AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN vIOLAIION OF THE F THE STATE OF WASHINGTON RELAHNG TO
FOR INSPECTION
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WORKMEN S CO.FEN E AND RCW 18,27
DATE
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I T�S UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL -FILE - YELLOW - INSP9CTOR
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109
FAX
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P ER UNIFORM BUILDING CODE SECTION�40,9_
At: 123 2d nuo S. Edm.nds,tWA 90020 Building P6qnit 12002-0104
Occupancy established by this cortiiicate: Dwelling Units: —NIA— No. Storiew, 2
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Owner of Building: USO t-;;—�.640r-ss:
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THE The Water Works. HAS ISEMIN b"'IIiWAJ REQUIREMENTS OF THE jjff-�EDITION OF
THE UNIFORM BUILDING CODE AS ADOPTED, �Fb D, CCUPANCY AND THE USE FOR WHICH THE
PROPOSED OCCUPANCY IS CLASSIFIED.
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DATE:—
J�MMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTNIENT DATE 02—
ENGINEERING DIVISION DATE --
PLANNING DIVISION DATE —
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DESCRIPTION OF WORK TO BE INSPECTED--r—,4�—�
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/contractorby inspector
1.
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owncr/contractorby inspector
1.
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
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Retaining Wall ...........
0
Slab Insulation ..........
PLUMBING:
.............
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Rough -in ....................
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Commercial Final
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HEATING:
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Gas Test ....................
GasPiping .................
Equipment .................
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EXTERIOR SHEATHING
NAILING
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FRAMING
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FIRST FLOOR FRAMING
INSULATION
...................
Floor Insulation
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Wall Insulation
Ceiling Insulation
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SHEETROCK NAILING
SPECIAL INSPECTION
0
ID
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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