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PERMIT
CITY OF EDMONDS INUMBER 75(7
CONSTRUCTION PERMIT APPLICATION 'POA.E.S; 'SUITEIAPTO
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Description
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Description
FEE
Plan Check
State Surcharge
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Building Permit
City Surcharge_
PLAN CHECK NO: 66-107
Plumbing
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THIS PERMIT A THORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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Grading
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BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBIC
WILL R U,
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION,
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00,005(AI(5)
Engr. Inspection
PERMIT LIMIT. SEE ECDC 19.00.005(A)(61
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHAL OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSOR$
Fire Review 36
Plan Chk. De��
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 DIRE TLY OR INDIRECTLY
Fire Inspection
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Receipt #
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT HALL NOT as
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Total Amt. Due .2113,15C
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CWY�S ABILITY TO ENFORCE ANY ORDINANCE PROVISION,
Recording Fee
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATI.N
APPLICATION APPROVAL
GIVEN IS CORRECT., AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED A ENT OF
Thi—ple,ele—r— p—eented s�qn,d by the
THE OWNER� I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL 8,,jdjIs offic,al or ner- o,puIy:,rd Foe, — p,,d,,,d
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
OF THE STATE Of WASHINGTON RELATING TO
FOR INSPECTION
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IN VIOLATION OF THE LABOR CODE
WORKMEN's COMPENSAT�l AND RCW 18:2
SIG DATE
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ATTENTION
EXT. 1333
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ITS UNLAWFULTO USE OROCCUPYA BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
�RI.WAJ/IUE YELLOW -INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. USC1091 IBC110 I IRC110.
PINK - CrWNER - GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COME
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FINAL PROJECT APPROVAL FORM
TO:-
DATE:-
MEMOTO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: DEPARTMENT DATE
INEERING DIVISION DATE
PLANNING DIVISION DATE -
PROJECT
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SITE ADDR�ESS 12 1)1�
PERMIT # S
*0'��_ADB#_________DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECT
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:
t-�GRAXT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
[I Copy of CONDITIONS given to owner/contractor by inspector
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:b1dg:fonns:ocaprv1 3/25/04
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Permit Inspection Details
Permit: BL020060409
PERIAIT-i-RAX
0711312006 Ed 20
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TotalTime: 20
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0711312006 Ed 20
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Total Time: 20
Total Inspections: 2
Total Time: 40
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6/1/2009 4:37:10 PM
Page I of I
�1-,�777777r
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION;
Footing ............
wall ..............
Pier/Porch ..............
Retaining Wall ...........
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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