20020691.pdfPERMITEXPIRES
6SE PERMIT
CITY OF EDMONDS ZONE NUMBER
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CONSTRUCTION PERMIT APPLICAT107N JOB SUITEtAPT#
OWNER NAf5V NESS ADDRESS
RUER PLAT NAMEISUBDIVISION NO. U NO�
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MAILING ADDRESS
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NO, OF FIXTURES
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ADDRESS
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REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAUt
NAME
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TELEPHONE
STATE LICENSE NUMBER
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(TYPE OF USE, BUSINESS OR ACT
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NIUMBER
OF
STORIES
NUMBER OF
DWELL NG
UNITS
CRITICAL
AREAS
NUMBER
DESCRIBE WORK TO BE DONE
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ALLOWED PROPOSED
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PR OPOSED SETBACKS (FT)
ALLOWED PROPOSED
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Description FEE Description FEE z
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Plan Check State Surcharge
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PLAN CHECK NO: VESTED DATE Plumbing 0
Mechanical
THIS PERMIT AUTHORIZES ONLY WE WORK NOTED. THIS PERMIT COVERS WORK TO
t 0 DOME ON PRIVATE PROPERTY ONLY. AMY CORSTRUCTON ON THE PUBLIC
Grading
2 , WILL REQUIRE
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.,
SEPARATE PERMISSION.
Engr. Review
2
PE MITAPPLICATION: INDAYS
PERMIT LIMM I YEAR - PROVID WORK IS STARTED WITHIN 180DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON 1EHA11 OF 111101 FIR SPOUSE, HEIRS, ASSIGNS AND succeSON,
Fire Review
PlanChk.Deposft
EREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS MOM ANYAND
rr,e Inspection
Receipt
ALL CLAIMS FOR DANA ES OF WRATEIE1 NATURE, ARISING GIIECTIY 1111 IND1110112Y
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
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Total Amt. Due
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR Lau r IN ANY WAY THE DRYS ABILITY TO ENFORCE AMY OPOINARICE P.ONIM.M'
Recording Fee
Receipt #
IHEREoy ACKNOWLEDGE THAT I FUWE HEAD THIS APPLICATION; THAT THE INFORMATION
APiTLIQATION APPRUVAL
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 CONSTAUC.
CALL
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TION; AND THORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATI IN VOIN9 TH OF THE STATE OF WASHINGTON REILATING TO
ON OF [HE
^NIN U`G`NCE
FOR INSPECTION
and Fees ate pald, at
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WORKMEN$ COMPENS AND RCW 1827.
F CI S I NATUR DATE
SIGNATURLJOWNER DATE III NED
(425)
2-
771-0220
BY DATE
ATTENTION
EXT 1333
_�%EASED
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
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GREEN CCOUNTING
FINAL PROJECT APPROVAL FORM
TO:_
DATE: —
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FIRE DEPARTMENT DATE-1=i---CLL--
FROM:
ENGINEERING DIVISION DATE—
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DESCRIPTION OF WORK To BE INSPECTED
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A field inspection was conducted to determine final compl lance with approved plans. Final approval
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denotes that there are no objections from the above signed Department to the release
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PERFO L_MANCEBONDS and the granting of:
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GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
a Copy of CORRECTION NOTICE given to owner/contractor by inspector
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2.
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date. Sign,
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS
FOUNDATION:
Footing
wall_ ........................
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Pier/Porch .............
0
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
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Undetground
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Rough -in ...................
0
Commerclal Final
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HEATING:
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Gas Test ..............
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Gas Piping .................
0
Equipment .................
Commercial Final
ITI IT
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EXTERIOR SHEATHING
0
0
NAILING ...............
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FRAMING ..............
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FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
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Wall Insulation ...........
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Ceiling Insulation
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SHEETROCK NAILING
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SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................