20020302.pdf2 DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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NAME
PERMIT EXPIRES
USE PERM T
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LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL $TREE I MAP
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REMARKS
OWNERIGONTRACTOR RESPONSIBLE FOR LROSION CONTrK
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REVIEWED/DATE
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DATE
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THIS PERMIT AUTHORIZES ONLY THE WORK 140T D. THIS PERMIT COVERS WORK TO
8 E DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PU BLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
GRADINGIFILL
SEPARATE PERMISSION.
PERMIT APPLICATION: 1.0 DAYS
R. PERMIT LIMIT.' I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG, REVIEW FEES
SEE BACK .1 PINK PERMIT 108 MORE INFORMATION
PPLICANT. ON EEHALF OF HIS OR HER SPOUSE, HEIRS, ASS$G
AA NS AND SUCCESORS
ENB, INSPECTION FEE
IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAP 140
2 EDMONDS, WASHiNGTON, ITS OFFICI LS, EMPLOYEES, AND AGENTS FROM ANY AND
INSPECTION FEE
A LCLAIMS FOR DAMAGESOF WHATEVER NATURE. ARISING DIRECTLY OR INDMECI,
RECEIPT
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE r THIS PERMIT SHALL NOT BE
DERAEDTOMODIF� WAIVE 09 REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
PLANCHECK DEPOSIT
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NORLIMITINANYWAYTII E CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
TOTAL AMOUNT DUE
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I HEREBY ACKNOWLEDGE THAT � HAVE REA THIS APPLICATION� THAT
GIVEN IS CORRECT, AN. THAT AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
THE OWNER I AGREE 0 ILYWITHCITYANO STATE LAWSREGULATMG CONSTRUC
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CALL
Thl. .1plKall- " 1-11 ow Fa- R
TION, AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
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IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
:CTI ON
FOR INSPECTION
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1—pt 11 1011, P"Ild1d,
LTHEINFORMrATON
WORKMEN'S COMPENSJ2ANCE AND ECI
OFFICIALS SIGNATURE AT
(4:25)
71-0220
7 1 0
RELEASEDBY DATE
ATTENTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
1
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE YELLOW INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER GOLD - ASSESSOR
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MEMO TO- PERMIT COORDINATOR, BUILDING DIVISION
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DESCRIPTION OF WORK TO BE INSPECTED-Y—,)'L- ZPJAI--1-0,
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A field inspection was conducted to determine final compliance with approved plans. Final approval
Department to the release of
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PERFORMANCE BONDS and the granting of:
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GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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0 copy ofCONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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RE -INSPECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
Date-. Sign---�
ocaprvl.doc.l:temp:bldg:formsIO/OI
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..� ............ ..........
Pier/Porch .................
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-04
Retaining Wall
Slab Insulation ..........
PLUMBING:
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Underground ..........
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Rough -in
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Commercial Final
R11
HEATING:
10
Gas Test
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Gas Piping .................
Equipment.................
Commercial Final
MITI
0 6
EXTERIOR SHEATHING
0
0
NAILING ..........................
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FRAMING
ITIO
FIRST FLOOR FRAMING_
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
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SHEETROCK NAILING
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SPECIAL INSPECTION
MISCELLANEOUS
FINAL APPROVAL FOR
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OCCUPANCY ..................