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( X FT)
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FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTI\�I�,EXPLAIN:
NUMBER NUMBER OF CRITICAL
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DESCRIBE WORK TO BE DONE
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PROGRESS INSPECTIONS PER UBC 108/ IBC109 / IRC109 FINAL INSPECTION RECI'D - 9
VALUATION
Description
Plan Check
FEE
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit
PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Grading
Engr. Review
cr PERMIT APPLICATION: ISO DAYS
W
CL PERMIT LIMIT1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
Description FEE
State Surcharge
City Surcharge
Base Fee
En 'APPLICANT, ON BEHALF OF HIS OR FIER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
TO THE
Fire Review
Plan Chk. Deposit
2 IN INTEREST, AGREES INDEMNIFY, DEFEND AND HOI D HARMLESS CITY OF
2 EDMONDS, WASHINGTO�. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
SHALL
x FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT NOT BE
Landscapelnsp.
Total Amt. Due
01�)
Ej DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
to
X1 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Receipt #
Recording Fee
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION
APPROVAL
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 CONSTRUC-
CALL
This application is riot a permit until signed by the
Deputy: Fees are and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LA CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Building Official or his/her and paid,
receipt is acknowledged in space provided.
WORKMEN'S COMPENS
URANCE AND RCW 16.27.
OFFICIALS DATE
SIGNATURE (OWNER 0, MEN
DATE SIGNED
(425)
rSAZTR
771-0220
HFtEASFD BY /DATE
ATTENTION
EXT 1333
ITIS UNLAWFULTOUSEOR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
0131GINAL FILE - YELLOW - INSPECTOR
PANCY HAS BEEN GRANTED. UBC109/1BC110/1RC110.
PINK - OWNER - GOLD - ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing .....................
Wa ...
Pier/Porch .................
Retaining Wall ......
"�Iab Insulation ..........
PLUMBING:
Underground ............
Rough -in ...................
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR M7-
OCCUPANCY ..................
'me Initials Ware Milton
Thompson, a temporary contract
inspector for the City.
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