20020118.pdfDATE RECEIVED
PERMIT EXPIRES
CITY OF EDMONDS
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ARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTAOLIDMINAGE
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STME LICENSE NUMBER EXPIRATION DATE
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REMARKS -iiii
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Plan Check
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PLAN CHEC VESTED DATE
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THIS PERMIT AUTHORIZES ONLY THE ORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC
Grading
,a d R g
Recording Fee
3 ONUUN (CURBS, SIDEWALKS, DRIVEWAYS MARQUEES, ETC.) WILL REQUIRE
a
- SEPARATE PERMISSION.
view
Engr. Review
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City Surcharge
PERMITAPPLICATION: IN DAYS
PERMIT LIM . I YEAR - PROVIDED WORK IS STARTED WITHIN Had DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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E 'on
Engr. Inspection At:�")
rig I so
State Surcharge
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
Traffic Mitigation
T"Ist". "'get'..
rE
Plan Chk Deposit
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
ANY AND
Fire Review
Receipt #
IOMONIS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT Be
Fire Inspection
Total Amount Due 4/15,
DEEMED TO MODIF%XWAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
01 NOR LIMITRI ANY W YTiE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
FRGcov, I
Landscapainsp.1
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I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
OWEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
.1i.n 1, rna. p—Ittedit.ignN ty Me
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VOLATIO I LASOI ODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
.,',ThIppI
ding Off2al or hi0her Derany: and Fees are paid. and
nAcept I, acknoefedged 1, spa,, provided.
WORK.... SATION INSURANCE AND RCVV 18.27,
OFFIC$A�S SIGNATURE
SIGNATU;�� SIGNED
kW:NE,,OR AGEW DAT
(425)
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2 //A5 2,0-
77 I
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1 -02220
RELEASED BY
ATTENTION
EX`T 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 - INSPECTO
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
FRO I M: FIRE DEPARTMENT DATE—
DATE_2LE0'Z-
04GINEERING DIVISION
PLANNING DIVISION DATE—
PROJECT—C (9,rk- EM CC D
SITE ADDRESS. �, 9 q-n- NemA R . ...........
PERMIT#,�O,)9-0 _ADB#______--PATEINSPECTE,)
DESCRIPTION OF WORK TO BE INSPECTED
A fleld in I spection was conducted to determine flnal compliance with approved plans. Final approval
denotes that there. are no objections from the above signed Department to the release of
PERFORMANCE BO_N_Dl and the granting of:
__�ZGRANT FLXAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WrIH CONDITIONS NOTED
t3 Copy of CONDITIONS given to owner/contractor by inspector
1.
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.—
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .............
FOUNDATION:
Footing ......................
Wall .........................
Pier/Porch ............
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Retaining Wall
Stab Insulation ..........
PLUMBING:
Underground .............
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Rough -in ...................
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Commercial Final
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HEATING:
-Test
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Gas ....................
Gas Piping .................
Equipment .............
Commercial Final
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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
SPECIAL INSPECTION
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..............
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