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PERMIT EXPIRES
CITY OF EDMONDS
US' ERMIT
ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION
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OWNER NAMEINAME OF AUS17ESS
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Deso ption
FEE
Description
FEE
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State Surcharge
HEAT SOURCE GLAZING % LOT 110111
. IT Permit
Building Permit
City Surcharge
PLAN CHEC �STED DATE
Plumbing
Mechanical
VBRR Ir FIX To
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON T E 5,
H FU LIC
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3 OMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, LIC.) Ve REQUIRE
1: SEPARATE PERMISSION.
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PE MITAPPLICATION: 159DAYS
PERMIT LIMm I YEAR - PROVID D WORK IS STARTED WITHIN 100 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk, Depos
IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD 11111,11,161 THE CITY 01
EDMONDS, WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY Me
Fire Inspect;on
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
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Total Amt. Due I /Of
DEEMED To MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF MY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CIrfS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee
I Receipt #
I HERESY ACKNOWLEDGE THAT � HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT', AND THAT AM THE OWNER. OR THE BURY AUTHORIZED AGENT OF
CONSTRUC.
no]. a net ""ad—til signed bydno
THE OWNER I AGREE TO COMP WITH CITY AND STATE LsoyS REGULATING
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
CALL
0 let 'h a/ - Barney and Foos are p.IdL.Pd
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IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON REIATING TO
WORKMEITS COMPENSATION INSURANCE AND ACW 111,27�
FOR INSPECTION
_WTURE
DATE SIGNED
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771-0220
JELEASED BY
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-
ORIGINAL - FILE - YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK�OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 6 COPIES GREEN � ACCOUNTING
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Waiver of Right of Appeal
File No.:
am the owner/agent for the owner, for the
above referenced permit application for real property located at:
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in Edmonds, Washington. By signing this agreement, I hereby agree to waive my right to appeal the
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decision on the permit application referenced above. I acknowledge that while I waive my right to appeal,
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the period for filing an appeal has not ended and another person or persons may file a va id appeal bef
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rt e ursuant to the
the appeal period ends. I hereby agree and fully understand that any actions I unde A p
above referenced permit, such as proceeding with any work under the permit prior to the expiration of the
that be
appeal period, are undertaken at my own risk. I further agree and understand any such actions may
may be revoked should a valid appeal be filed
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stayed in the event of appeal, or the underlying approval
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ies the above ed permit.
and upheld which voids or modif
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I certify that I have read and understand/ Fprovisions of this agreement and agree to be bound
by
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such.
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Owne Date:
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8.6.2002
FIN AL PROJE& APPROVAL FO
TO:-
DATE-44,1z"i
MEMOTO: PEPMITCOOPD]NATOR,BUJIDINGDrVISION
FROM: -FIRE DEPARTMENT DATE -
ENGINEERING DIVISION DATE -
PLANNING DIVISION DATE
PROJECT
SITE ADDRESS-
PERmrr DATE INSPECTED-
___,��ADB#
DESCRIPTION OF WORK TO BE INSPECTED
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
PERFORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
cl Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
[3 Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
Date- Sign,
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RECORD OF MSPECTION�
INSPECTOR
DATE APPROVED
SET13ACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
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Commercial Final
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HEATING:
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Gas Test
Gas Piping ...............
Equipment ..............
Commercial Final
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EXTERIOR SHEATHING
NAILING ..........................
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FRAMING ........................
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FIRST FLOOR FRAMING
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INSULATION ...................
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Floor Insulation
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Wall Insulation ...........
Ceiling Insulation
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SHEETROCK NAILING
SPECIAL INSPECTION
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
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OCCUPANCY ..............