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USE PERMIT
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CITY OF EDMONDS N 5Zilej NUMBER
CONSTRUCTION PERMIT APPLICATION 'AODRESS CIC, SUITE
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PLAT NAMEISUBDIVISION NO, I LOT NO. LID �Q(,
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ING ADER Be LID FEE $
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METER SIZE I
LINE SIZE
I NO. OF FIXTURES
PRV REQUIRED
YES E3 NO 0
A .. —E.S REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRIMNAGE
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NAME
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FIRE REVIEWED By DATE
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VARIANCE OR CU SHORELINE OR A117 INS.P.E.C�
STATE LICENSE NUMBER 5 -If EXPI"TION DATE C POSTED
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
1: B "O"EO"""VATEPIIII--ONII,--II—U-IONON THE PUSLR`
Grading Recording Fee
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REG IRE
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SEPARATEPEFIMISSION. Go City Surcharge
Emir. Review
PERMITAPPUCATI N: ISODAYS
PERMIT UMM I YEAR WORK
-PROVID D IS STARTED WITHIN URIDAYS Engr. Inspectio State Surcharge
61 BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLIOAK ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Traffic Mitigation Plan Chk Deposit
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IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
a EDMONDS WASHINGTON ITS 0 FICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Review Receipt #
ALL ENZ -11 DAMA�ie OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM T.EBISBANCE OF PERMIT. ISSUANCE F THIS PERMIT SHALL NOT BE Fire inspection ()us
DEEMED TO MODIFY WAIVE OIRS REDUCE ANY REQUIREMENT CITY ORDINANCE Total Amount
OF ANY
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
.1 Landscapainsp.1 Receipt #
I HERSEY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
GWEN IS CORRECT� AND THAT AM THE OWNER, OR 7HE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
THE OWNER. I AGREE TO C..P1Y WITH CITY AND STATE LAW. E.U.N. CONSTRUG' CALL This appReel.er lareco. purell.aIll sigrenHeyffi.
T.011. AN. IN GOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED BuiOng Official or his/her Dapuey� and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt 13aokrov�lpdged firope,ce p—Idod.
WORKMENS COMPENS:22MRANCE AND RCW 18 27.
SIGNED (425)
=sag 771-0220
RELEASED Y DATE
/ATTENTION EXT 1333
411/7ta— �j ?)02
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. ORIGINAC-FILE OW - INSPE TOR
(,oc-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK OWNER ASSESSOR
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FINALZR--OJECT APPROVAL FORM
TO:�,.
DATE:-& 110 LO ?_
MEMO TO: PERMIT COORDINATOR, BUff-DING DIVISION
FROM: FIRE DEPARTMENT DATE
ENGINEERING DIVISION DATE
PLANNING DIVISION DATE
PROJECT qq LQ IPAA3"_�
SITEADDRBSS
PERMIT#_2LgZ� �?_B# DATF INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED —'s
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:
RECEIVEL,
-GRANT FINAL PROJECT APPROVAL JUN 10 2002
ENGINEERING, DIVISION
GRANT PROJECT APPROVAL wrrH CONDITIONS NOTED
a Copy of CONDITIONS given to owner/contractor by inspector
\FAILED FINAL INSPECTION - OUTSTANDING ISSUES
opy of CORRECTION NOTICE given to owner/cntractor b
A# y inspector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
Date Sign
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FINAL PROJECT APPROVAL FORM
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DATE: -
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: -FIRE DEPARTNIENT DATI�__
ENGINEERING DIVISION DATE_!L0_t0L
PLANNING DIVISION DATE-
PROJECT�_\q
SITE ADDRESS 011.10 omb aAA)
PERA41T #_qA6A0 q,�� =--ADB#-DATI INSPECTED_!W�
DESCRIPTION OF WORK TO BE INSPECTED
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A fleld 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 BOMS and the granting of
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL.INSPECTION - OUTSTANDING ISSUES
o Copy of CORRECTION NOTICE given to owner/contractorby inspector
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 ...............
wall .............
PledPorch ..........
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Retaining Wall
Slab Insulation ..........
PLUMBING.
Underground .............
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Rough -in ...................
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Commercial Final
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HEATING:
1711
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GasTest ...............
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Gas Piping .................
Equipment
Commercial Final
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EXTERIOR SHEATHING
NAILING ................
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FRAMING ............
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FIRST FLOOR FRAMING
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INSULATION ..................
j Floor Insulation
wall Insulation
Ceiling Insulation
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SHEETROCK NAILING
SPECIAL INSPECTION
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ................
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