20020217.pdfECEIVED
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PERMIT EXPIRES
CITY OF EDMONDS
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CONSTRUCTION PERMIT APPLICATION
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ADDRESS
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PLAT NAMEISUBDIVISION NO.
I LOT 110. UII NO.
MAILING ADDRESS
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PUBLIC RIGHT OF WAY PER OFFICIAL
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REQUIRED DEDICATION—
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REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION COAT
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ADDRESS
—ENGINEERING
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PROP ED SETBACKS (FLI
`ADDITION
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FRONT LJYJIDE REAR
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DESCRIBE WORK TO BE DONE
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REMARKS
PROGRESS INSPECTIONS PER USC 10S/FINAL INSPECTION R9Q'D
as
VALUATION $
Description FEE
Plan Check
Building
PLAN '7z vE
lumbing
THIS PERM[TAUTHORMS ONLYTHEWORK NOTED. THIS PERMIT COVERS WORK TO
Mechanical
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ORTHE a
D APU LIC
ONAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) Will EQUIRE
Grading
Recording Fee
It SEPARATE PERMISSION.
Engr. Review City Surcharge
A Ur
PERMIT LIMITI. I PROVIDED WORK IS STARTED WITHIN IN DAYS
SEEILAc'
IIA001"POIK PERMIT 10. stORUNFORMATION
Engr. Inspection ZA�
State Surcharge
—PLIO . ON BEHALF OF H15 OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
iTHE
Traffic Mitigation
Plan Chk Deposit 7
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
Fire Review
Receipt III
ALL CLAIMS "",=BE, 0, WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM T.ELSSU OF THIS 11E.1,11T. ISSUANCE OF THIS ERMIT $HALL NOT E
DEEMED To MODIFY, WAIV NY
OR REDUCE ANY REQUIREMENT OF A CITYORDINANCE
Fire inspection
Due e�-'7 j
HE
NOAUMU"INANYWAYT E CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION'
W
Landscape Insp.
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I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
OWNER. I AGREE TO COMPLY Will' CRY AND STATE A REGULATING ONSTRUC.
CALL
I his OPPflaaflm Is nin a permit will Signed by the
TI.N; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
B,Itding Offld,l a, his her 00ptay: and Fees Om paid. and
IN VIOLATION OF THE ALTAJONOR CODE OF THE STATE OF WASHINGTON RELATING TO
III WORKMENS COMPENS INSURANCE AND RCW 18.27.
FOR INSPECTION
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OILS SIGNATURE DATE
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RELEASED BY DAT—E
ATTENTION
EX'r 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
T,
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
10101
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
NEMO TO: PERMIT COORDINATOR, 13UILDING DIVISION
FROM: DEPARTNIENT DATE
---------.gNGINEERING DIVISION DATE-21�0
PLANNING DIVISION DATE
PROJEC
SITEADDRESS,
P ERMrr ADB# —1W- 0 E
# ---PATEINSPECTED
DESCRIPTION OF WORK TO BE INSPECTED
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
PEREO_RMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
ci Copy of CONDITIONS given to owner/contractor by inspector
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 Sign__
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS ............
FOUNDATION:
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A -d 5
Footing ..........
Wall ..........................
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Pier/Porch
Retaining Wall
Slab Insulation ..........
PLUMBING:
M
Underground
171
Rough -in ...................
Commercial Final
M
M Z.
10 —11
HEATING.
Gas Test ............
Gas Piping ..............
Equipment ..........
x
M
Commercial Final
M
EXTERIOR SHEATHING
0
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NAILING ..............
0
FRAMING ..............
FIRST FLOOR FRAMING
INSULATION ................... VY)S
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Floor Insulation
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Wall Insulation ...........
Calling Insulation
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SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
17