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City Surcharge
PERMrrAPPUCATiON: INDAYS
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SEE ACK OF PINK PEAMlT FOR MORE INFORMATION
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-1UCAN7, Oil 01-LI 01 HIS OR HER 1-USE. HEAR. ASSIGNS AND 1U0CE1ORS
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Traffic Mitigation
Plan Chk Deposit
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
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EDMONDS, WASHINGTON, III OFFICIALS, EMPLOYEES, AIDAGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Fire Review
Receipt #
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Fire
Tota[AmountOue
DEEMED To MODIFY, H AN TY
WAIVE OR REDUCE ANY REQUIREMENT OF Y CITY ORDINANCE
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Receipt #
I HEREBY ACKNOW DOE THAT I HAVE READ THIS APP )CATION: THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
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THE OWNER. I AGIE 10 CO.11 WITH CITY AND STATE _ RE.UITIN. C.NSTRUc_
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CALL
Has application Is not a pannalt until signed by Me
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TIft AND IN DING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF TH LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Bull 0 f1dal .1 hillhal D.ruty� and Foos are paid. and
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WORKMEN'S COMPENSATION INSURANCE AND RCW 1827
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771-0220
ENTION
EXT 1333
IT IS UNLAWFUL T 0 USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE YELLOW � INSPECT 8
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER GOLD - ASSESSOR
10/01
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FINAL PPQJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE —
ENGINEERING DIVISION DATE—
��PLANNING DIVISION DATF—fo
PROJECT'
SITEADDRESS
PERMIT a&-g -0',�-5�ADB#_______--DATE INSPECTED —
DESCRIPTION OF WORK TO BE INSPECTED -
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
GRAN,,, r APPROVAL WITH CONDITIONS NOTED
u Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
a Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date— Sigri�
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS ............
FOUNDATION:
Footing ......................
wall ................
Pier/Porch ...........
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Retaining Wall
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Slab Insulation ..........
PLUMBING:
Underground .............
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Rough -in . ..................
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Commercial Final
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HEATING:
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Gas Test ....................
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 ...........
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Ceiling Insulation
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SHEETROCK NAILING
SPECIAL INSPECTION
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................