20020390.pdff
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PERMIT
CITY OF EDMONDS
NUMBER
CONSTRUCTION PERMIT APPLICATION
SUITE/APIN
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PLAT NAMEISUBDIVISION NO.
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THIS PER Izes
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DOMAIN JCURBS, SIDEWALKS, DRIVEWAY , MARQUEES, ETC�) WILL REGUIRE
GRADINGIFiLL
SEPARATE PEFUSAISSION.
STATE SURCHARGE
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P MIT AIILICATI..: 190 DAYS
A.
PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
NO HE
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'A PLICANT. ON BEH ALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
END. INSPECTION FEE
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IN FIT BREST AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
E MONDE, WASHINGTON, ITS OFFICIALS. EMPLOYEES AND AGENTS FROM ANY AND
A L CLAIMS FOR DAMAGESOF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
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RECEIPT
FROM THE ISSUANCE OF THIS PERMIT. ISS ANCE OF THIS PERMIT SHALL NOT S E
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENTOF ANYCITY ORDINANCE
PLAN CHECK DEPOSIT
NOR LIMIT INANYWAYTHE CITWS ABILITY TO ENFORCE ANYORDINANCE PROVISION"
TOTAL AMOUNT DUE
TOT L
F-70-177--
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I HEREB ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION,
APPLICATION
APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
T EOWNER I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC�
CALL
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TION AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL HE EMP DYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RE LATING TO
FOR INSPECTION
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WORKIIEN'SCO�PENIATIONIU�,URANCE AND RCW 18,27,
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DAT E SIGNED
(425)
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771-0220
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ATTENTION
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s DATE
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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-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
ORIGINAL - FILE YELLOW INSPECTOR
PINK - OWNER GOLD - ASSESSOR
LOT 3-065,
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FINAL PROJECT APEROVAL FORM
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DATE:
MEMOTO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: ---YME DEPARTNIENT DATE—
____yNGINEE DIVISION DATE —
PLANNING DIVISION DATE
PROJECT
SITE ADDRESS— Yn
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PERMIT Y1 0 ADB# 0 4ATEIINSPECTED—
DESCRIPTION OF WORK TO BE INSPECTED s I C�
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
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
a 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
I
2.
3.
RE
,-INSPECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
Date Sign_
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ..............
FOUNDATION:
Footing ......................
Wall ...................
Pier/Porch .................
Retaining Wall ...........
Stab Insulation
PLUMBING:
Underground
Rough -in ...................
Commercial Final
HEATING:
GasTest ....................
Gas Piping ................. 7--
Equipment
Commercial Final
EXTERIOR SHEATHING
NAILING .....................
FRAMING ........................
FIRST FLOOR FRAMING
INSULATION ..........
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
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