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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY ANY CONSTRUCTION ON THE PUBUG
Grading
Recording Fee
7 DOMAIN (CURBS, MARQUEES, ETC.) WILL REQUIRE
t SEPARATE PERMISSION.
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Engr. Review
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City Surcharge S,
aB! PER MIT APPMCATIOk: 100 DAYS
PERMIT LIMmiYFAR
MT
- PROVIDED WORK IS STARTED WITHIN 180 DAYS
DEC BACK OF PINK PERMIT FOR MORE INFORMATION
Engr.inspection
i State Surcharge
rrR. 'APPLICANT ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Traffic Mitigation
Plan Chk Deposit C "
A� IN INTEREST, AGREES TO INDEMNIFY DEFEND AND HOLD HARMLESS THE CITY OF
a EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Review
RBDaipi#�/J
old' ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Fire Inspection
Total Amount DUe �li
S NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION -
Landscape Insp.
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Recelpt #
ACKNOWLEDGE
I HEREBY GIVEN S CORRECT, ND THAT 1 AM THAVEHE OWNER, OR THE DULY AUTHORIZED AGENTREAD THIS APPUCATIOnL THAT THE ION OF
APPLICATION APPR91oz-
OWNER. IAGREETOCOPLY WITH CITY AND STATE LAWS REGULATING CONSTRUE
CALL
TNH applicTION;
AND IN DOING THE WORK AUTHOg12E0 THEREOY, NO PERSON WILL BE EMPLOYED
VIOLATION O THE LABOR CODE OF THE STATE OF WASHINGTON BEIATING TO
P EATIONINSURANCE AND RCW 10.2T.
FOR INSPECTION
BOIIdrag Official at his/her Deputy: and FooIN
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S`I ( ER AGE DATE
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
7�1-0221
ATHE
FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
OF OCCUPANCY HAS BEEN GRANTED, UDC SECTION 109
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
ENGINEERING DIMION DATE l O O Z
PLANNING DIVISION DATE
PROJECT 1'f7� � X
SITE ADDRESS 10:1 Z-2 V
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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 WITH CONDITIONS NOTED
a Copy of CONDITIONS given to owner/contractor by inspector "
1,
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
a Copy of CORRECTION NOTICE given to owner/contractor by inspector
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2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign
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RECORD OF INSPECTIONS
.. _..
INSPECTOR
DATE APPROVED
OZ
SETBACKS .....................�..�t
' FOUNDATION:
Footing .....................:
iWait ..........................
Pier/Porch .................
Retaining Weil............
-
7
Slab Insulation ..........
�.
PLUMBING:
j
Underground .............
Rough -in .......:.
Commercial Final ......
l HEATING:
Gas Test.. :......... .
i
.. .;. .Gas Piping .................
.
Equipment ...........
' - Commercial Final .......
EXTERIOR SHEATHING
1Q
NAILING ..........................
...
I
"FRAMING ........................
_. FIRST FLOOR FRAMING...
S
- Sri-7'02 .. `....
jINSULATION ...................
Floor Insulation .........
Wall Insulation .:....:....
..
I Ceiling Insulation .......
SHEETROCK NAILING
- SPECIAL INSPECTION ...
MISCELLANEOUS ......:_.
. FINAL APPROVAL FOR
' OCCUPANCY...................Non