20040401.pdfA/
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F E13MIT EXPIF�IES
CITY OF EDMONDS
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PERMIT
NUMBER
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COMPLIANCE OR
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REMARKS
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Description
FEE Description FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
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Building Permit
—
City Surcharge
PLAN CHECK NO* VESTED DATE
LIL /
Plumbing
Base Fee
____ - -
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
ui PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 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. Deposit
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W IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMIESS THE CITY OF
2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt N
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIREC RY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
C3 QUIREMENI OF ANY CITY ORDINANCE
DEEMED 10 MODIF'� WAIVE OR REDUCE ANY RE
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Total Amt. Due
�2
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0 1 TYS ABILITY 10 ENFORCE ANY ORDINANCE PROVISION,"
NOR LIMIT IN ANY WAY THE C
Receipt #
1:
Recording Fee
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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
I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
I his application is not a permit until signed by the
THE OWNER.
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
RELATING TO
Building 011icial of his/her Deputy: and Fees are paid, and
FOR INSPECTION receipt is acknowledged in space provided.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON
WORKMEN'S COMPENSATION INSURANCE AND RCW 18 27.
jFFI I f4ATURE DATE
SIGNATURE (0 DATE SIGNED
11- NT�
(425)
'ALS
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771-0220
FTS P'67
'R ME I
NTION
EXT 1333
/IT IS UNLAWFUL TO USE OR OCCUPY A 13UILDING 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
09/03 PRESS HARD -YOU
ARE MAKING 4 COPIES
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FINAL PROJECT APPROVAL FORM
RECEWED TO:
OCT - 6 2004
DEVELOPME14T SERVICES CTR.
CITY OF EDMONDS
MEMO TO:
FROM:
nZASE SIGN
DATE:
INGDIVISION
DEPARTMENT DATE
ENGINEERING DIVISION DATE----�
?LUSE SIGN
PLANNING DIVISION DATE
PLEASE SIGN
PROJECT -70 3 k 5
SITE ADDRESS -
PERMIT B#-----.DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED
ermine final compliance with approved plans. Final approval'
A field inspection was conducted to det igned Department to the release* oU
denotes that there are no objections from the above s
and the granting of
T FINAL PROJECT APPROVAL
4L 12 0
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to owner/contraLctor by inspector
1 -
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to ovmer/contractor by inspector
I .
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Si
Date
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing .............. .......
Wall ..........................
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Pier/Porch ................. 0
0
Retaining Wall ........... M
Slab Insulation ..........
PLUMBING:
M
Underground ............. C
M 0
0
Rough -in ................... 0
0 C
Commercial Final ...... M
M z
HEATING:
Gas Test .................... )5_04
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Gas Piping ................. _42i cn.
-n
0
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Equipment .................
Commercial Final ....... M M
0
0
EXTERIOR SHEATHING
0 M
NAILING .......................... C Cf)
FRAMING ........................ Q 0
Z
FIRST FLOOR FRAMING ...
.INSULATION ...................
3:
Floor Insulation ......... z
Wall Insulation ...........
Cn
z
Ceiling Insulation ....... 0
SHEETROCK NAILING ... 0
M
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................