20020403.pdfDATE RECEIVED
PERMIT EXPIRES
PERM T
CITY OF EDMONDS NUMBERP ",/
S
UITEIAPT,
CONSTRUCTION PERMIT APPLICATION 'AODRESS V,54?t&1,2
OWNER NAMEINA�E OF BUSINESS PLAT NAMEISUBDIVISION NO. I LOT NO, LID NO.
6&0`� &A1 e M r- 1) 0 c LID FEE $
MAILINIGADbRESS
PUBLIC FIGHT OF WAY PER OFFICIAL STREET MAP Ina P_,,
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NAME MIT. SIZE I LINE SIZE .0- .1 FIXTURES IRV FE.UIlII
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REMARKS
J!' OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY ZIP P E NGpomd oc- ReWo epost o
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NAME
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FIRE REVIEWED BY
DATE
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EXP
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REQUIRED SETBACKS IFT�) PROPOSED SETBACKS (FT.)
FRONT SIDE FEAR FRONT UPSIDE REAR
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CHANGE OF USE
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NUMBER NUM ES OF
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DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 1001FINAL INSPECTION REO'
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PLAN CHECK NO:
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOT D. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC
GRAMNGIFILL
RAON"In"LL
E DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPL=TI.W 140 DAYS
T A E E IT A E
T U CH RG
PERMIT LIMIT, 1 YEAR * PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
IN P '0
ENO. INSPECTION FEE
-
'APPLICANT, ON BEHAL OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
a IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
L EG P
LANDSCAPING
EDMONDS. WASHINGTON ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
OF THIS ISSUANCE OF THIS PERMIT SHALL NOT BE
INSPECTION FEE
RECE17 /�/6
FROM THE ISSUANCE PERMIT.
D5EMEDTO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
PLAN CHECK DEPOSIT
'ON '
0 N OR LIMIT IN ANY WAYTHE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION,
CEIPT/qg� 57016
TOTAL AMOUNT DUE
TOT
IRS t
ATION
T
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFORM4
APPLICATION APPROVAL
EC TO
GIVEN IS CORR T, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
Th'. p'n.I pan.1 nnt" .1gn.d �y In.
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
YEG
WILL BE EMPLOYED
CALL
Oln,jal P, hl,Met Doputy: and F .. ... p,ad, and
TION. AND IN DOING THE RK AUTHORIZED THEREBY, NO PERSON
THE LAID CO I INGION RELATING TO
THE STATE 01 WASH
FOR INSPECTION
.—pt 1. a�w a 0. 'In P p'-d.d.
IN VI
GO I �UFA E AND RCW I8Z7.
WOR40 MENSATION�
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OP S SIGNATURE DATE
CA% D
SIGNA USE (OW E� AGE9��[ 1
(425)
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141
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""Y 'ATE'
Wft-WION
EXT 333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
-/),-2
A FINAL INS PECTION 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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FINAL PROJECT APPROVAL FORM
TO:
DATE: —
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE—
rn la &-iLT ENGINEERING DIVISION DATE ..... ..... q.1
PLANNING DIVISION DATE-
-PROJECT W1JK00G--
SITE ADDRESS A 0,
PERMIT #
z�3,ADB#--------PATE 'NsPECTED-2-440 -q-
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
GRANT PROJECT APPROVAL WrM CONDITIONS NOTED
u Copy of CONDITIONS given to owner/contractorby inspector
1.
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
a Copy of CORRECTION NOTICE given to owner/contractorby inspector
1.
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date�_ Si
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS ..................
FOUNDATION:
Footing ......................
4,
wall ...........
Pier/Porch ...............
Retainlrig Wall ...........
Slab Insulation ..........
PLUMBING:
Underground
Rough -in .. .................
Commercial Final
HEATING:
GasTest ...............
Gas Piping .................
Equipment .. ...............
Commercial Final
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
Wall Insulation . ..........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
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