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PERMIT EXPIRES
CITY OF EDMONDS
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CONSTRUCTION PERMIT APPLICATION
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ADDRESS 4363
OWNER NAMEMAME OF BUSINESS
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Description
Description FEE Description FEE
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Plan Check State Surcharge
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DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS MARQUEES. ETC.) WILL REQUIRE
ETC , WILL REQUIRE
SEPARATE PERMiSSION.
PE MyTAPPLICATION: 180DAYS
Engr. Review
PERMIT LIMM I YEAR - PROVID D WORK IS STARTED WITHIN HIDDAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICAMIL ON BEHALF OF HIS OR HER SPOUSE, HEIRS ASSIGNS AND SUC ESORS
Fire Revisys, Plan Chls. Deposit
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 #
ALI CLAIMS 1011=GES OF WHATEVER I NATURE ARISING DIRECTLY ..INDIRECTLY
FROM THErSSU 0, THIS PERMIT SSUANC� OF THIS PERMIT SHALL NOT BE
Landscapeinsp. Total Amt. Due
DEEMED To MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY C TY ORDINANCE
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NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION,
Recording Fee Receipt #
I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
IS CORRECT,
APPLICATION APPROVAL
GIVEN AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THEOWNE . I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSIRUC.
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CALL Thin appecidion Isnot a pinnelt Inall signed by Me
TION; AND DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATI ON OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMENS C4NSAR N INSURANCE AND ACW 18,27.
Sultding0flicialolls, a, DOPUsy: and Foes are paid. and
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FOR INSPECTION __.aaIPI ia.1kaI.dp0d1 11 $PICO Pswidld,
OR AGIN 0 E SIGNED
1 CIA S SI NATURE DATE
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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-
CAT OF OCCUPANCY HAS BEEN GRANTED.
E UBC SECTION 109
ORIGINAL FILE - YELLOW � INSPECT
PINK -OWNER - GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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FINAL PROJECT APPROVAL FORM
TO-
DATE%&_C_9_�,' 200Z
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: DEPARTMENT DATE —
ENGINEERING DIVISION DATE_,&�.�4i5),--
PLANNING DIVISION DATE—
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DESCRIPTION OF WORK TO BE INSPECTE1)___,&ZZd,,�_—_ —
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A field Inspection was conducted to determine final compliance with approved plans. Final approval
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denotes that there are no objections from the above signed Department to the rele se of
BONDS and the granting of
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GRANT FINAL PROJECT APPROVAL
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FAILED FINAL INSPECTION -OUTSTANDING ISSUES
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a Copy of CORRECTION NOTICE given to owner/commctorby inspector
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RE INSPECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
Date_ Sigo—
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FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECT16N
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY
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