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ADDRESS REMARKS
OWNER/CONIRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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CITY ZIP TELEPHONE
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D J 5
PLAN CHE70.
VESTED DATE
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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 THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
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PERMIT APPLICATION: 180DAYS
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PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
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W IN INTEREST AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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EDMONDS. I�ASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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4 ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
T FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF I HIS PERM11 SHALL NOT BE
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DEEMED TO MODIFN� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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0 NOR LIMIT IN ANY WAY THE CITYS ABILTlYTO ENFORCE ANY ORDINANCE PROVISION
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I HEREBY ACKNOWLEDGE THAT I LIAVE READ 1111S APPLICATION; THAT THE INFORMATION
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
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW W,27.
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L (OWNER OR, EN
DATE SIGNED
LSIGNATUIRE
VAL >ATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
FEE
Description
State Surcharge
City Surcharge
Base Fee
CALL
FOR INSPECTION
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I 1 11""' RELEASED BY
ATTENTION LA I I jjj
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR S I RUG I UHL 1-1114 1 IL.
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
09iO3 PRESS HARD -YOU ARE MAKING 4 COPIES
PINK
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAI
1 his application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
FFf,IALS SIGNATURE DAT E
YELLOW -INSPECTOR
GOLD - ASSESSOR
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FINAL PROJECTAPPROVAL FORM
TO:
ATE:
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MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASE SIGN
ENGINEERING DIVISION DATE
PLF,%SE SIGN
PLANNING DIVISION DATE
PLEASC SIGN
PROJECT --- S-t?
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SITE ADDRESS— rL
PERMIT #
DATE INSPECTED 213
DESCRIPTION OF WORK TO BE INSPECTED Z2 7
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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
El Copy of CONDITIONS given to owner/contractor by inspector
1. 1
FAILED 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 SignatUre
1:ten1p:b1dg:f6rrrLs:ocaprv1 3/25/04
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FINAL PROJECTA�PROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASE SIGN
ENGINEERING DIVISION DATE
PLEASE SIGN
o PLANNING DIVISION DATE
PLEASESIGN
PROJECT
SITE ADDRESS -
PERMIT# Af)1111 DATEINSPECTED
DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine compliance with -approved plans. Final approval
the release of
denotes that there are no objections from the above signed Department to
PERFORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to owner/contractor by inspector
I .
FAILED 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 Signature
1: temp:b Idg: forms: ocaprO 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
/--"*Wall
..........................
Pier/Porch .................
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Wall
Vol
Retaining ...........
Slab 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
OCCUPANCY ..................
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