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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
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CL PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
in -APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
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ud IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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2 EDMONDS, WASHINGTON, I TS OFFICIALS, EMPLOYEES. AND AGENI S FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NAT URE. ARISING DIRECTLY OR INDIRECTLY
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0 DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY C11 Y ORDINANCE
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I HEREBY ACKNOWLEDGE THAII I HAVE READ THIS APPLICAl ION. THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THEOWNER I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION, AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELAI ING TO
WORKMEN S COMPENSATION INSURANCE AND RCW IS 27
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RE (OVONER OFY,CGFNT! DAIE SIGNED
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YES 0 NO 0
REMARKS
OWNERCONTRACTOR RESPONSIBLE FOR EF�OSION CONTROL/DRAINAGE
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ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
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LOT COVERAGE I REQUIRED SETBACKS (FT.) I PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE� REAR I FRONT UR SIDE RE I a
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TOTALAVOUNI DUE te;ir
AP 3LICATION APPROVAL
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CALL Building Off cial or his/hP., Deputy. and Fees are paid. and
FOR INSPECTION recc �pt is acknowledged in space provided.
I ��qIALS �5NATURE DAT E
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771-0220
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASE SIGN
ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE
PLEASE SIGN
PROYECT
SITE ADDRESS?, 1- 6 3 2- 1 --JI
PERMIT ADB# DATE INSPECTED
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DESCRIPTION OF WORK TO BE INSPECTED
RECEIVED
FEB 2 6 2004
DEVELOPMENT SERVICES CTR.
CITY OF EDMONDS
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: . I%"
>�_GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
o Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inspector
1 .
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Si
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
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Retaining Wall ........... 0
Slab Insulation .......... 0
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PLUMBING:
Underground .............
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Rough -In . ................. M
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Commercial Final ...... 0 0
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HEATING: M M
M Z
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Gas Test ....................
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Gas Piping .................
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Equipment .................
Commercial Final .......
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EXTERIOR SHEATHING
NAILING .......................... 0 Cn
0
0
1711
FRAMING ........................ Cf)
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FIRST FLOOR FRAMING ... Q 0
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INSULATION ................... 711
Floor Insulation ......... 3:
Wall Insulation ........... z
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Ceiling Insulation ....... Cn
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SHEETROCK NAILING ... 0
SPECIAL INSPECTION ... 0
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................