20000051.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. T.IS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS , MARQUEES, ETC.) WILL REQUIRE
GRADINGIFILL
SEMRATE PERMISSION.
STATE SURCHARGE
4,
P FLMIT APPLICATI N: 180 DAYS
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PERMIT LIMIT. 1 YEAR, PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
A P LICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
ENG. INSP ION FEE
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I A I NTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
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2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM A.YAND
ALLCI-AIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
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RECEIPT —
I FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
PLAN CHECK DEPOSIT
1,;�,2 3
0 NOR LIMIT IN ANY WAY THE CIlY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
RECEIPT
TOTAL AMOUNT DUE
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFORMATION
APPLI ATION
APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER. OR THE DUI AUTHORIZED AGENT 01
THEOWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTIRUC
CALL
Th� - . .....
TION: AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
8,,Id,,g 011ilill 11 hi,ih,, DlPltY: 1�d F111 ,, p1ld. ..d
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
INSPECTION
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
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CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
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ADDRESS
DATE:
""'DESIGN DATA ****'
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NOTES.*
1. Call Engineering Division (771-MO) for a tightline and detention System inspection
before backfil[ing and for final inspections.
OVED BY
2, Responsibility for operation and maintenance of drainage ustem On private PrOPertY is the
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ibility of tho property owner. Material accumulated in the storage pipe must be flushed
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P ect Name:
ProjectAddress: Receipt Date: 441
Underground Wiring Required
Hydraulics Permit
Plat/Subdivision Requirements
Street Dedications
Easements - Public/Private
Engineering Storm Drain Review Feel
Engineering 2.2 Inspection Fee
Drainage Plan (On -site)
Setback - Storm Drain Line
Open Ditch - Existing
Culvert Required
Culvert Size
Shoulder Drainage/Shale Open Runoff
Catch Basin Required
Driveway Slope & Vehicle Access
Sidewalk Required
Curb & Gutter Required
curb Cut for Driveway Required
Street Paving Required
Right -of -Way Construction Permit Required
Bond Required for Public Improvements
FEMA Map Check/water Table
Side Sewer Availability
calculate Sewer Fee ifNo LID#
Water Meter Size
water Meter Charge Required
Hydrant Required
Street Cut
Miscellaneous
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Meter Size Paid$ Date Receipt#
FINAL -PROJECT APPROVAL FO
TO:
DATE:
MEMO TO: PERNOT COORDINATOR, BUILDING DIVISION
FROM: DEPARTMENT DATE
DIVISION DATE q16 I-'9d
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DESCRIPTION OF WORK TO BE INSPECTE
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A field inspection was conducted to determine compliance with approved plans. Final approval denotes that
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Bonds ass ociated with the project may be released
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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1177
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
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SETBACKS ......................... . . . ......
FOUNDATION:
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Slab Insulation ..........
PLUMBING:
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Commercial Final
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Gas Test ....................
Gas Piping .................
Equipment .. ...............
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Commercial Final
EXTERIOR SHEAT14IN G
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FRAMING .........................
FIRST FLOOR FRAMING...
INSULATION ................
Floor Insulation
411
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Ceiling Insulation
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SHEETROCK NAILING
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SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ...........
ATE RECEIVED RMIT EXPIRES
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION JOB
ADDRESS
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PERMIT-Z �12000'5'1 A
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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
WILL REQUIRE
GRADIN'tFILL
2 DOMAIN (CURDS. SIDEWALKS, DRIVEWAYS , MARQUEES, ETC.)
:1 SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT APPLICATION! 180 DAYS
0 KI
PERMIT LIMIT.- 1 YEAR � ROVIDED WOR S STARTED WITHIN 110 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
;APPLICANT. ON BEHALF F HIS OF HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
HARMLESS THE CITY OF
ENG. INSPECTION FEE
Ij N INTEREST. AGREES T :NDEMNIIY. DEFEND AND HOLD
TS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANYAND
OFWH EVER NATURE, ARISING DIRECTLY OR INDIRECTLY
RECEIPT
5 PERMIT SHALL NOT BE
OF ANY CITY ORDINANCE
ORDINANCE PROVISION.-
PLAN CHECK DEPOSIT
RECEIPT
TOTAL AMOUNT DUG
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
Thi, Ppl,,.[,.n 11 n-1 A p,,.il ,bl lIgnld by th,
THE 0 NE . I A FEE T M PLY WITH CITY AN D STATE LAWS REGULATING CONSTRUC
WILL BE EMPLOYED
CALL B.,tdi.9 On, �j j.p,X, And F— — P--
RK AUTHORIZED THEREBY. No PERSON
TO ;ANDIND INGTHEW R ODE OF THE STATE OF WASHINGTON RELATING TO
LABO
FOR INSPECTION
—.ip- mkn—dg.� in �p— p—W.d.
IN LATION OF THE
EN'S COMPFNSATIqN INSURANCE ANDACW 18.27.
OFF �TUFE DATE
(425)
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SIGN El 0 GENTI
771-0220
LEASED BY
-A:FT ENTiON
EXT 333
.
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
"
FINAL INSPECTION H AS BEEN MADE AND APP ROVAL OR A CERTIFI-
OhIGI NA L - FILE IELLOW-INSP6CTOR
ASSESSOR
A
C�TE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
P, NX OWNER GOLD -
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