20020594.pdfDATE RECEIVED
CITY OF EDMONDS PEURIMBIER
CONSTRUCTION PERMIT APPLICATION JOB
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ADDRESS REMARKS
NERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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Description
FEE
Description
FEE
Plan Check
State Surcharge
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Building Permit City Surcharge
PLAN CHECK NO: :STED DATE Plumbing
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Mechanical
THIS PERMIT AUTHORIZED ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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8 DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON -a PURUC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
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PERMITAPPLICATION: ISKIDAYS
PERMIT LIM YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPII ANT, ON BEHALF OF HIS OR HER SPOUSE� HEIRS ASSIGNS AND SUCCESORS Fire ReVim Plan Chk. Deposit
IN INTCREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLE S THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, 1111"')YEE1, AND AGENTS FROM ANY AN. Fire Inspection Receipt #
ALL CILAIMS FOR DAMAGES OF WHATEVER NATURE, As DING DIRECTLY OR INDIRECTLY
FROM THE I=NCE OF THIS PERMIT. ISSUANCE F THIS PERMIT SHALL NOT BE
D�EMFU 10 REQUIREMENT OF ANY CITY ORDINANCE Landscapoinsp. Total Amt. Due
I A
FY WAIVE OR REDUCE ANY
NOR LIMIT IN ANY W�y THE CITYS AINUTY To ENFORCE ANY ORDINANCE PROVISION,.
Recording Fee Receipt #
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAI
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. I
appi ntion is not a re -it darl signed It, the
CALL
StenThis
0 ding Officitti or heft, Oep,ty: and Fees one paid, and
TION; AND IN DOING THE WORK AUTH RIZED THEREBY NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON REUTING TO FOR INSPECTION tod,lpt Is ackamindgidl 1, speed PmIded.
AORKMEITS),?"SATION INSURANCE AND RCW 18.27. OFFICI
'EN T) DATE SIOIED (425)
lb�_() L & - () 1-
I I I -urr.'Ll RELEASED BY DATt
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- OR�GINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GnANTED. USC SECTION 109 PNK-OWNER GOUD-ASSESSOR
04/02
PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM:
FIRE DEPARTMENT DATE
ENGINEERING DIVISION DATEA I zi 0 2-
-PLANNING DIVISION DATE
'PROJECT
SITEADDRESS lqtL Ible y\J
:PERMIT# qb -650( ADB#--------PATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED WL
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 ATIH CONDITIONS NOTED
a Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
E3 Copy of CORRECTION NOTICE given to owner/contractor by inspector
1.
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 ............
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Slab Insulation ..........
PLUMBING:
Underground ..........
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Rough -In ................
0
Commercial Final
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HEATING:
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Gas Test ....................
Gas Piping .................
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Equipment .................
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Commercial Final
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EXTERIOR SHEATHING
0
NAILING .............. ...........
0
FRAMING ....................
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IT! 0
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
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0
SHEETROCK NAILING
0
SPECIAL INSPECTION
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ...........