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OWNER NAME/NAME OF 13USINESS PLAT NAME/SuBDIVISION NO LOT NO. LID NO.
LID FEE
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inspection Rimmied
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STATE LICENSE NUMBER E]YES ONO S
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V 111A A SEPA REVIE ALLOWED PROPOSED
COMPLETE EXEMPT ALLOWED PROPOSED
PROPERTY TAX ACCOUNT PARCEL NO.
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COMPLIANCE OR z
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ADDITION ,13LCOMMERCIAL PARKING LOT AREA PLANNING REVIEWED BY DATE 0.
REMODEL 1:1 MULTIFAMILY 11 SIGN REO'D PROVIDED
— FENCE
REPAIR 13 GRADING CYDS ( x FT) REMARKS
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DEMOLISH 11 TANK
GARAGE RETAINING WALL FIRE SPRINKLER
z CARPORT ROCKERY 0 FIRE ALARM
0 (TYPE OF USE. BUSINE70R ACTIVITY) EXPLAI CHECKED BY TYPE OF CONSTRUCTION CODE OCCUPANJ'
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U) NUMBER NUMBER OF . SPECIAL INSPECTION AREA . !�9
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0 OF DWELLING NUMBER REQUIRED [] YES
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0 STORIES 0
DE§qRIBE WORK TO BE DONE REMARKS 7
LIJ PROGRESS INSPECTIONS PER UBC I 08/FINAL INSPECTION REQ'D ES
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VALUATION
Description FEE Description FEE
Plan Check State Surcharge
HEAT OURCE ULAZINU 70 LOT SLOP % Building Per it City Surcharge
VESTED DATE Plumbing Base Fee
PLAN CH"' 1
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: ISODAYS
w STARTED WITHIN 180 DAYS Engr. Inspection
CL PERMIT LIMIT. I YEAR - PROVIDED WORK IS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Fire Review Plan Chk. Deposit
U) 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
U) ESS THE CITY OF
UA EST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARML
IN INTER Fire Inspection Receipt #
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2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY On INDIRECTLY Z, i_,�r
MIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Total Amt. Due
x FROM THE ISSUANCE OF THIS PER Landscapelnsp.
IFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
DEEMED TO MOD ANY ORDINANCE PROVISION.-
Y WAY THE CITYS ABILITY TO ENFORCE cording Fee Receipt #
0 NOR LIMIT IN AN Re
I HEREBY -_ ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
IS CORRECT AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF This application is riot a permit unfilsigned by the
GIVEN CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building Official or his/her Deputy: and Fees ate paid. and
THE OWNER. I AGR�E TO COMPLY WITH No PERSON WILL BE EMPLOYED receipt is acknowledged in space provided.
TION AND IN DOING THE WORK AUTHORIZED THEREBY. R INSPECTION
IN V;6LATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FO
WORKMEN'S COMPENSATION INSURANCE AND RCW IB.27. OFFICIALS SIGNATURE DATE
_JDATE SIGNED (425)
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SIGNATURE low
4fan By
7, UT__D4TE I
4 771-0220
EXT 1333
A ENTION STRUCTURE UNTIL
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR
E AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW, IN9 ECT R
A FINAL INSPECTION HAS BEEN MAD NTED. UBC SECTION 109 PINK - OWNER GOLD ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRA
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE �11�9 164
PL,
SP SIGN
ENGINEERING DIVISION DATE
PLEASESIGN
PLANNING DIVISION DATE
PLEASE SIGN
PROJECT
SITE ADDRESS L] -2, Lt
PERMIT #_2����.ADB# ------- --.DATE INSPECTED_1_���
DESCRIPTI ON OF WORK TO BE INSPECTED K
A field inspection was conducted to determine 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
1:1 Copy of CONDITIONS given to owner/contractor by inspector
FA-ILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date SignatLire
1:temp:b1dg:fomis:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
SETBACKS . .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
C�b Underground .............
Rough -In ...................
ry 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
OCCUPANCY ..................
INSPECTOR DATE APPROVED
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