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104" R'CS It, O'L PERMIT EXPIRES
USE PERMIT
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CITY OF EDMONDS NUMBER7
CONSTRUCTION PERMIT APPLICATION JOB kyoz BOW DOI Q W-tj SUMIAPT#
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OWNER NAMEtNAME OF BUSINESS C-RIC AilLIDd-RfL-N PLAT NAME/SUBDIVISION NO ------ I OT NO IJO NO.
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I MAILING ADDRESS LID FEE S
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PRV REQUIRED
ARCH I rEcr YE . SO NO - 13 9
NAME
ADDRESS REMARKS
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OWNERICONTRACTOR RESPONSIBLE FOR EROSION
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TELEPHONE
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NAME
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ENGINEERING REVtEWE(
ADDRESS CIT9 LIC tf
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FIRE REVIEWED BY
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STATE LICENSE NUMBER
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COMPLETE EXEMPT
PROPERTY ACCO PARCEIL NO.
113, R�90_
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El PLUMBING / MECH
LOT COVERAGE
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COMPLIANC OR
CHANGE OF USE
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GARAGE RETAININGWALL F SPRINKLER
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ARPORT ROOKERY RE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
DATE
DATE
INSPECTION BOND
POSTED
jYrSE No Is
REQUIRED sEr:ACKSEA(FT)'j PROPOSED SETBACKS IFF)
FRONT SID A RL FRONT LIA SIDE REAR
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N6jraHA30RW00 BUTIMIS.C17/12ETAIL CHECKED By 7
NUMBER OF
NUMBER 7 1 CRITICAL p(
OF DWELLIN AREAS SPECIAL INSPECTION AREA
STORIES UNITS NUMBER REQUIRED YES
DESCRIBE WORK TO BE DONE k-rucco ouviog REMA KS
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F'ROGRESS CINSPECTIONS PER UBC
FEE
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OCCUPANT
LOAD
001FINAL INSPECTION REaD
Description fEE
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Plan Check
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State Surcharge
HWAURCE SWING % LOT SLOPE %
Building Permit 7�
�j City Surcharge
PLAN CHECK IN
ol I VESTED DATE
Plumbing
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THIS PERMIT AUTHORIZES ONLYTHE WORK NOTED. THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY. AM CONSTRUCTION ON THE PUBLIC
Grading
2 U
3 DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS MARQUEES, ETCj WILL RED IRE
ffHE
I: SEPARATEPIERMISSION.
PEAMRAPPLICATION: INDAYS
PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180DAYS
Engr. inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
*APPLICANT, ON BEHAL OF His OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
90MONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
Fire Inspection
Receipt If
IALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE I SUANCE OF THIS PERMIT. ISSUANCE F THIS PERMIT $HALL NOT
9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF A Y CITY ORDINANCE
Landscapelnsp.
Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITY$ ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
— —
R Ing Fee
2=
Receipt #
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
THE OWNER I AGREE TO COMPLY WITH C17Y AND STATE LAWS REGULATING CONSTRUC-
CALL
ThIspPlIcation is not a pentut until signed by the
TtON; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Suit dint outtisI.I., WWII., O,P.IY, and I`- psid, tund
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WORKMEN'S COMPEN��E�CE AND RCW 18.27�
OFFICIALS SIGNATURE DATE
W DATE I.NE
SIGNATURk (0 HER 0 0
(425)
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P-N -02
ATTENTION
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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 - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK - OWNER - GOLD -ASSESSOR
04102 PRESS HARD -YOU ARE
MAKING 5 COPIES GREEN - ACCOUNTING
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FINAL PROJECT APPROVAL _FORM
TO: ��4-
DATE:
MEMO TO: pERMrr COORDINATOR, BUILDING DIVISION
FROM: DEPARTMENT DATE—
G DIVISION DATE —
PLANNING DIVISION DATE__LZj.L, 4
PROJECT----,,
SITEADDRESS—
PERMIT oa&,Zj-,� �ADB#
__AL-L��DATE INSPECTED`-- 1.116,12-4
DESCRIPTION OF WORK TO BE INSPECTED
A I rxeid inspection was conducted to determine rinal 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:
V--' GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
(3 Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES -GRANT FINAL PROJECT APPROVAL
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:,
Footing ......................
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Pier/Porch
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Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
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Rough -in ...................
30
Commercial Final
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HEATING:
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Gas Test ..........
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Gas Piping .................
Equipment . ................
Commercial Final
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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 ................
Floor Insulation
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Wall Insulation ...........
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Ceiling Insulation
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SHEETROCK NAILING
SPECIAL INSPECTION
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
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OCCUPANCY ..................
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