20020512.pdff
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
IEWNER AMEINAME OF ALSINPq
'AILING ADDRESS
IT' ZIP T ONE
PERMIT EXPIRES �2�_T
77 PERMIT
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JOB / $111EI
ADDRESS
1112
FLAT NAME�SUBDIVISION NO, �LOT NO, LID
LID FEE S
PUBLIC HIGHT OF WAY PER OFFICIAL STREET MAP T-1-I.- 5-
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EXISTING - PROPOSE. 0
0
PEOUIREDDEDICATION- FT 0
0. OF FIXTURES PRV REQUIRED
YES 0 NO 0
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAMt I
CITY ZIP
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STATE LICENSE NUMBER 117NIATE
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REMARKS
PC PER USC 108FINAL INSPECTION REO'D
VALUATION
FEE
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HEAT SOURCE GLAZING I LOT SLOPE %
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PLAN CHECK N �TED DATE
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THIS PERMIT AUTHO IZES NLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
-
t BE DONE ON PRIVATE PROPER Y ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS* MARQUEES, ETC.) WILL REQUIRE
GRADINGIFILL
SEPARATE PERMISSION.
IT= SURCHARGE
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PE MITAIILICATION: 180DAYS
PERMIT LIMIT. I YEAR�PROVIDEDW AK IS STARTED WITHIN 180OAYS
ENG, REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
PLICANT. ON BEHALF 01 HIS OR HER SPOUSE, HEIRS. ASSIGNS AND 11CCESOIS
ING, INSPECTION FEE
IN NTESEST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLE THE CITY OF
IS
LANDSCAPING
, IT
2 ED.ONDS� WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENT OM ANY AND
INSPECTION FEE
ALL CL�Allllvll FOR DAMAGE OFWHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
B CEIPT
I FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PER.IT'SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE AN REQUIREMENT OF ANY C TY ORDINANCE
PLAN CHECK DEPOSIT
0 OR LIMIT IN ANYWAY THE CITY-1 ABILITY T. ENFORCE AI,IY.NDIJ,4ANCE PROVISION.
N
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TOTAL AMOHNT DUE
IN 174ij
BMATION
IHERF Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFO MARCH
APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CoNSTRUC
CALL
"I"" A "', I, " �., 1,,
TION. AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLAT ON OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
I
[FO FR INSPECTION
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'ATTENTION
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
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A FINAL INSPECTION HAS SEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL FILE YELLOW - SPE OR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
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FINAL PROJECT APPROVAL FORM
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DATE:-A�()Z—
MEMO TO: PERM COORDINATOR, BUILDING DIVISION
FROM: ME DEPAMIENT DATE —
ENGINEERING DIVISION DATE—
PLANNINGDIVISIONDATE-��-
PROJECT � (i �,, Ow n i W,
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PERMIT# --tG-05)1�2 ADB#—Q22-12J—DATEINSPECTEP-'
DESCRIPTION OF WORK TO BE INSPECTFD—' Z
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
PERFORALANCE B and the granting of
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WrM CONDITIONS NOTED
u Copy of CONDITIONS given to owner/contractorby inspector
FARM FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contractor by inspector
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RE-INSpECTM OUTSTANDING ISSUES -GRANT FINAL PROJECT APPROVAL
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
BE TBACKS
FOUNDATION:
Footing......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground.............
Rough -in ..........
Commercial Final
HEATING:
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
.
FIRST FLOOR FR4MING...
INSULATION ...................
Floor Insulation
Wall Insulation
Calling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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