20020428.pdf0
DATE RECEIVED
us' PERMIT
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CITY OF EDMONDS
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CONSTRUCTION PERMIT APPLICATION
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Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE 6�ING % LOT SLOPE %
Building Permit
City Surcharge
DATE
PLAN CHECK NO: VESTED
Plumbing
Mechanical
THIS PERMIT AUTHORIMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORKTO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQuEZ% ErC4 WILL REQUIRE
3 SEPARATE PERMISSION,
Engr, Review
PERVITAPPLICATI N: INDAYS
W ITT
PERMIT LIMM I YEAR -PROVIDED ORKISSTA EDWITHINIBODAYS
SEE BACK OF PINK PERMIT MR MORE INFORMATION
APPLIOM ON 11-LF 011111 OR HER SPOUSE, NEIRS�ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HO D HARMLESS THE CITY F
EDMONDS, WASHJNGTON� ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt N
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANC' OF IS PERMIT, ISSUANCE OF rHIS PERMIT SHALL NOT BE
ANY CITY ORDINANCE
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Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISICN.-
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Recording Fee
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMA71ON
APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
Thl—pplication 15,0t a pormhunfil signedbyMe
El TO C S REGULATING CONSTRUC-
RED IA1' OM"Y ""'I CITY AND 'TAT' LAW
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IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
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FOR INSPECTION pllkl� P1.1d
WORKMENZ C=�ARON INSURANCE AND RCW 18-27.
OFFICIAL S SIGNATORE DATE
SIG14 D�TE IGN 0
(425)
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771-0220
RELEASED By I DATE
ATTENTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE YELLOW . INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK - OWNER GOLD - ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
GREEN - ACCOUNTING
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERM[IT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE—
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67? —ENGINEERING DIVISION DATE
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PLANNING DIVISION DATE-
PROJECT�—
SITE ADDRESS
PERMIT# 6�00Q-e!�-qf9 ADB#-------PATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED.04JWL(n�,
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 COND171TONS 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 Sign—
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ............
wall
Pier/Porch ...............
Retaining Wall ...........
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Slab Insulation ..........
0
PLUMBING:
Underground
Rough -in ...................
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Commercial Final
0
HEATINrx
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Gas 76�t
GasPIping
Equipment .................
0 Tl
Commercial Final
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EXTERIOR SHEATHING
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NAILING ............. ............
FRAMING ..........
0
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..........
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FIRST FLOOR FRAMING
T. 0
INSULATION ...................
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Floor Insulation
Wall Insulation ...........
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Ceiling Insulation
SHEETROCK NAILING
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SPECIAL INSPECTION
0
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..............
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