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PERMIT EXPIRES
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CITY OF EDMONDS IN MBER
CONSTRUCTION PERMIT APPLICATION ADDRESS 9q SUIfE1APT#
NAMEINAME OF BUSINESS
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MAILING ADDRESS EE $
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ADDRESS REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLI.—NA-
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CITY LEP ONE FIRE REVIEWED BY DATE
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PRO REQ'D
GRESS INSPECTIONS PER UBC 110111FINAL INSPECTION
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: D DONE ON PRIVATE PROPERTY ONLY. AM CONSTRUCTION ON THE PUBLIC
2 DOMAIN JCURSS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
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SEPARATE PERMISSION.
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PE MITAPPUCATION: 180DAYS
PERMIT LIMrR I YEAR - PROVID D WORK IS STARTED WITHIN 100 DAYS Engr. Inspection 50
SEE SACK OF PINK PERMIT FOR MORE INFORMATION
N EIEHAL OF Is on HER .1.U.S. ..I.S. ASSIGNS AND SUCCESORS Fire Ravi" 1,
;APILTICANT
N . ERE� AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WAIHIN ON. ITS OFFICIALS, EMPLOYEES. -11 AGENTS FROM ANY AND Fire Inspection Receipt# :7- CI z Z V
A. CLAIMS FOR DAGMTA ES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE (IF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
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DEEMED TO MODIFY. WAIVE ON RE LOS ANY REQUIREMENT OF ANY CITY ORDINANCE
PROVISION.-
0! NOR LIMIT INANYWAYT E CITYS ABILITY 10 ENFORCE ANY ORDINANCE
Recording roe
I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
T IS OWNER. I AGREE TO COMPLY WITH CI AND STATE LAWS REGULATING CONSTRUC, ThIppft.LJ.A 1� ft. PR11 �igmd by III.
CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED B,IldfAg OffidM., hl� h., D�pjy: IIIK, F p.1d, �nd
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION _ipl 1-6-10g.d IA �p r—Id.d.
ORKMENS COMPENSATION INSURANCE AND RCW 18,27.
SIGNATURE DATE
(425) �7,IALS
771-0220 REIT D By DATE
ATTENTION Off 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL -7
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFi- On GINAL� FILE YELLOW - INSPEATOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PZ-OWNES GOLO-ASSESSOH
04102 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
FINAL PROJECT APPROVAL FORM
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DATE:
MEMO TO: PEMM COORDINATOR, BUILDING DIVISION
FMDEPARTMENTDAT
FROM:
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PLANNING DIVISION DATE-
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A field inspection was conducted to determine final compliance with approved plans. Final approval
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GRANT FINAL PROJECT APPROVAL
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a Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contractorby inspector
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RE_lNSpECTED 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 ...........
Slab Insulation ..........
PLUMBING:
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Underground
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Rough -In ...................
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Commercial Final
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HEATING:
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GasTest .................
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Gas Piping .............
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Equipment .................
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Commercial Final
EXTERIOR SHEATHING
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NAILING ........... ..........
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FRAMING ........................
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FIRST FLOOR FRAMING
INSULATION .............
Floor Insulation
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Wall Insulation
Ceiling Insulation
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SHEETROCK NAILING
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SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ............
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