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CONSTRUCTION PERMIT APPLICATION
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OWNER NAMEINAME OF BUSINESS 6121c Afvoeaseiv
PLAT NAMEJSUBDIVISION NO. LOT NO
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PROGRESS INSPECTIONS PER USC 1081FINAL INSPECTION REGrO
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Description
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Plan Check
State Surcharge
HEAT SOURCE GLAZING %
LOT SLOPE %
Building Permit
City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE ORKNOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUERJ
2 C
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
PE MITAPPUCATION; 180DAYS Engr. Review
PERMIT LIMIT I YEAR - PROVIDED ORK IS STARTED WITHIN 100 DAYS Engr. Inspection
SEE 13ACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF Of HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS Fire Review Plan Chk, Deposit &0
IN INTEREST. AGREES To INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt # zl�3��
ALL CLAIMS FOR DAMAGES 01 ATEVE NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUAN ' OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIV A OR RE UCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapainsp. I Total Amt. Due
NOR LIMIT IN ANY W�Y`T'HVEECITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- Recording Fee Receipt #
I HERESY ACKNOWLE BE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVE IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
is ,,!fROVAL
T E OWNER. I AGREE TO COMPLY WITH CITY AND STAT LAWS REGULATING CONSTRUC CALL "�s �FP'X� op hisignadbyKne
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TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYE "tU 9.011 1%.1 his
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IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TOD FOR INSPECTION " P 7�.�kn.wlod d In sp— pnnndod.
WORKMEWE COMPENSATIG=RANCE AND Now 18.27.
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131�51LIRE IOWNEII OFfkGEN3r-I TATE SIGNED (425)
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DATE
�7ASED`BY�
ATTENTION Off 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, INSPECTO
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109 PINK - OWNER GOLD -ASSESSOR
04102 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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FINAL PROJECT APPROVAL F
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DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE -
ENGINEERING DIVISION DATE_
PLANNING DIVISION DATE
PROJECT
SITEADDRESSL
PERMIT #A&A_2_1��ADB# DATE INSPECTED
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
PE WANCE 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
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contmetor by inspector
2.
3.
RE-INSPECTFD OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
wall............ .............
Pier/Porch .... .............
Retaining Wall ...........
Slab Insulation
PLUMBING:
Underground
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Rough -In ...............
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Commercial Final
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HEATING:
GasTest ....................
Gas Piping
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Equipment .............
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EXTERIOR SHEATHING
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NAILING ..........................
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FRAMING ........................
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FIRST FLOOR FRAMING...
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INSULATION ...................
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Floor Insulation
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Wall Insulation ...........
Ceiling Insulation
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SHEETROCK NAILING
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SPECIAL INSPECTION
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MISCELLANEOUS ..........
FINAL APPROVAL FOR Ez
OCCUPANCY ..................
4:960*4- 4064561