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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2 Grading
=I DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION. Engr. Review
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10 PERMIT APPLICATION: 180 DAYS
CL PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 160 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
to 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
M EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
13 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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Fire Review
Plan Chk. Deposit
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
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GIVEN IS CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
TPPLICATION APPROVAL
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THE OWNER. I AGREE TO COMPLY WIFH CITY AND STATE LAWS REGULATING CONSTRUC-
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TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EM _ PLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
CALL
FOR INSPECTION
This 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.
WORKMEN'S COMPENSATION INSURANCE AND RCW 10.27.
---------
OFFICIALS SIGN E ATE
SIGNATURE 0 ED (425)
_,7.�VNER Off EN DATE SIGN
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771-0220 RELEASED BYt DA
ATTEfjTIQ1!1V EXT 1333
ITIS UNL^FULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
ORIGIIIAL - FI ELL -INS CTOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. PINK-OWN'R GOLD - ASSESSoR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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CITY OF EDMONDS
121 5TH AVENUE NORTM -EDMONDS. WA98020 - (425) 771-0220 -FAX (425) 771-0221
Website: wwwdedmondsmams
DEVELOPMENT SERVICES DEPARTMENT
99\3 Manning * Build "y "y "UU1 "y
12/28/04
Edmonds Family Medicine Clinic
7315 212th St SW
Suite 101
Edmonds, WA 98026
Building Permit: 2004-0941
Site Address: 7315 212th St SW, Ste 101
ExpirationDate: 11/10/05
GARY HAAKENSON
MAYOR
The purpose of this letter is to inforni you that the last remaining inspection on your
project is a final inspcction(s). The final inspection(s) detern ines that t ere are no
outstanding life -safety issues and approval allows the City to close your permit file.
The City considers the final inspection to be one of the most important inspections
conducted on a project. In order to grant final approval the following must be complete:
smoke detectors, house numbers, guardrails, handrails, self -close doors between garage
and residence, egress from sleeping rooms, safety glazing, weather-stripping, any
Engineering department requirements etc. Of course not all of these things may
specifically apply to your project but it does give you an idea about the kinds of things
that must be complete as well as some items that do not need to be installed such as:
paint, carpet, moldings, wallpaper, etc. Please be advised permits expire one year from
the date of issuance. If you will need more time to complete the work, permits can be
renewed prior to expiration for one half fees. If the permit expires withouta final
approval granted by the Building Inspector, full fees are required in order to renew the
permit. This can be very costly to you and we strongly encourage you to check your
permit expiration date and call for the required final inspection(s). Note: If more than
one department is required to final your project, this is noted on your Job Card.
Please feel free to contact me at 425-771-0220 if you have any questions.
Sincerely,
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Permit Coordinator
Incorporated August 11, 1890
Sister Citv - Hekinan. Jar)an
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FINAL PROJECT APPROVAL FORM
DATE:
MEMOTO: PE71 CtD LDING DIVISION
FROM: =FIRE DEPARTMENT DATE
/ LEASESIGN —ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE
PLEASE SIGN
PROJECT If (III-1c 6-.2 t C_
SITE ADDRESS 17 15 2-o3
PERMIT# 0,4-?_4_L_ADB# DATEINSPECTED
DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine compliance with -approved plaits. Final approval
denotes that there are no objections from the above signed Department to the release of
PERFORNIANCE 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
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
F71 Copy of CORRECTION NOTICE given to owncr/contractor by iiipector
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:tei1ip:b1dg:fortns:ocapr%,1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground.............
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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 ..................
4?00 VOW 409 91/ &00**0/
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