20020803.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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7HISPERMITAInHORIZESO WILHEWORKNOTED, THIS PER;IT COVERS WORKT(
BEDONEONPRIVATEP OPEM ONLY. ANY CONSTRUCTION ON THE PUBLIC
ALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PEFIMITAPPUCATION: 1WDAYS
PERMIT LIMM. I YEAR -PROVIDED WORK IS STARTED WITHIN INDAYS
SEE BACK OF PINK PERMIT FOR MORS INFORMATION
;APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEHISLA SIGNS AND SUCCESOR
N INTEREST. AGREES TO INDEMNIFY. DEFEND AND HO D HARMLESS THE CITY 0
2 EDMONDS WASHINGTON* na OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
IALL CLAIMii FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUA14CE OF MIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT 8
!3 DEEMED TO MORIFV, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANC
PERMIT EXPIRES
u7E__ PERMIT
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PLAT NAMEJSUSDAASION NO� LOT NO. LiD
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LINE SIZE
NO. OF FIXTURES
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REMARKS
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REMARKS
PROGRESS INSPECTIONS PER USC 108/FINAL INSPECTION REOD
VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Ulcharge
Plumbing
Mechanical
Grading
Engr. REVIEW
Engr. Inspection
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Receipt It
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Total Amt. DUO
NOR LIMIT IN ANYWAY THE CITYS ABILITY TO ENFORCE ANY
Recording Fee
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Receipt
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IMEREBY ACKNOWLEDGE THAT I HAW READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION
APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORII D AGENT OF
THE OWNER. I BEE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
AD
CALL
This appli-Lon Is nut - Paunit until slaned bY IhO
Building Officts! o, hK/hw O.inwyi nd F.s. p.1d, ..d
TJON� AND IN EMPLOYED
DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE NO
IN VIOLATIO LABOR ODE OF THE STAT OF WASHINGTON REILATI TO
FOR INSPECTION
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WOPKMEN.S ATION INSURANCE AND RCW 18.21,
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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:
DATE: -
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE—�
3 ERING DIVISION DATE—LEI-01'-
PLANNING DIVISION DATE,
PROJECT
SITEADDRESS—lum �S� YJ
PERMIT B#----------PATE INSPECTED--�
DESCRIPTION OF WORK To BE INSPECTED_Lt.6D 161&a
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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
PERFO_RMANCE 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/contractor by inspector
2.
3.
RE-lNSPECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
Date-- Sign----
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ............
7
z
Wall ... ...............
i�_,
4v
Pier/Porch .................
0
M
Retaining Wall
Stab Insulation ..........
PLUMBING:
M
Underground
IT!
0
0
C
Rough -in ...................
M
ITI
Commercial Final
C
HEATING:
Gas Test ..........
Gas Piping .................
Equipment .................
3:
M M
Commercial Final
0
EXTERIOR SHEATHING
c
NAILING ..........................
IT! 0
FRAMING .......................
Al
FIRST FLOOR FRAMING
INSULATION ..............
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Floor Insulation
Wall Insulation ...........
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Coiling Insulation
SHEETROCK NAILING
ITI
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
20'02