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PERMIT EXPIRES
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FEE —
Description
FEE
Plan Check
G T 8 L 0 P E
HEAT SOURCE SLAZING LOT 1LOPE
B Id
Building
U I It g
a T a D DA T E
PLAN CHECK NO: STED DATE
b IT
Plumb n,
P I In
Mechanical
M u
a h I.
M e.' It
R - 0 V To
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
.
- N LE P -
U
DEO DOME ON PRIVATE PROPERTY ONLY. AM CONSTRUCTION ON THE PUBLIC
0
n
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Grading
g
.codn. 'a.
Recording Fee
C W I a R
0 MAIN (CURBS, SIDEWALKS, DRIVEWAYS MARQUEES, ETC.) WILL REQUIRE
SEPARATEFERMISSION.
E V W
Engr. Review
En�, .v,.w
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City Surcharge
CR,.Urch.Ig.r
PERMIT APPLICATION: INDAYS
'as A S
PERMIT LURE I YEM - PROVIDED W04K 15 STARTED WITHIN ISO DAYS
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ng'. "Spec
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State Surcharge
A 0
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'
I N_ Al I. - UTS..
-APPLICANT, ON BEML OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
'
K"
at
Traffic Mitigation
ta ,Hg
T IT
Plan Chk Deposit
,I S HE CITY OF
As M LE S
IN INTEREST. AGREES TO INDEMNIFY DEFEND AND HOLD HARMLESS THE CITY OF
Receipt #
A ENTS -M ANY AN.
3 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
DIRECTLY OR 'ND.E., Ly
AI.LCLAIMS FOR DAMAGES OFWHUGEVER NATURE ARISING DIRECTLY OR INDIRECI LY
E IT S_LL Nor BE
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCi OF THIS PERMIT SMALL NOT BE
Fire Review
FIT R.V,.w
Total Amount Due
or RU N
Ty N
ANY 0 INA E
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINA CE
FIT UIS . B IT
Fire Inspection
p
-RD ANCa PROVISION
0 NOR LIMIT IN ANY WAY THE C"S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.
#
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Receipt
T HAT THE I OR n.
NF -A ON
I HEREBY ACKNOWLEDGE THAT I HAVE RM THIS APPLICATION; THAT THE INFORMATI
ON AP PROVAL
AUTHORIZED AGENT OF
GIVEN IS CORRECT: AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
.SGU,T,.. CONSTRUC
THE OWNER. I AGRE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
ALL
CALL
C
�Ip�d by ffi.
SON WILL . MPwYsU
N; AND IN DOING WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
TIO TH
UI.ToN FELAT.N. To
IN VIOLATION OF THE 'LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
0 1 SP C
S
.. 1. IPt$1kn..I di-p—P-1d,
WORKMENa Cq_MR4�NSATION INSURANCE AND RCW 18,27.
0 F1 IA SIGNATURE
S:ZE (O�W _jATE SIGNED
(425)
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11 LL.;�
771-0220
R DATE
BY
ATTENTION L11
M 1333
JEASED
IT IS UNLAWFUL To USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL -FILER YELLOW -INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. LED SECTION 109
FAX
PINK. OWNE GOLD , ASSESSOR
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I FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE—
D ENGINEERING DIVISION DATE
PLANNING DIVISION DATE—
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PROJECT
snm ADDRESS
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ADB --------pATE INSPECTED 10'�
PERMIT# #
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DESCRIPTION OF WORK TO 13E INSPECTED—JaO&LLA!�9,--
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A field inspection was conducted to determine final compliance with approved plans. Final approval,
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denotes that there are no objections from the above signed Department to the release of
PERFORMANCE BONDS and the granting of:
1" �GRANT
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FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
u Copy ofCONDITIONS given to owner/contractorby inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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a Copy of CORRECTION NOTICE given to owner/contractor bY inspector
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2.
3.
RE-INSpECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
Date— Sign_
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACK$ .....................
FOUNDATION:
Footing ......................
wall.....................
PierlPorch
Retaining Wall
Slab Insulation ..........
0
PLUMBING:
Underground .............
Rough -in ...................
0 M
C
0
Commercial Final
0
C
HEATING:
-4 K
M
Gas Test ..................
ITI
Gas Piping
>
Equipment .................
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Commercial Final
EXTERIOR SHEATHING
M M
NAILING ..........................
0
FRAMING ........................
0 f:
m
FIRST FLOOR FRAMING...
IT! 0
INSULATION ...................
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Floor Insulation
-4
Wall Insulation ...........
x
>
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Ceiling Insulation
SHEETROCK NAILING
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SPECIAL INSPECTION
0
M
MISCELLANEOUS
FINAL APPROVAL FOR
OCCUPANCY ..............
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