20000257.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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FLAT NAMEJSUBDIViSION NO.
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REQUIRED DEDICATION— PT
METER SIZE UNE.SIlE
NO, OF IIXTUIES
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YES C3 No 0
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FIRE REVIEWED By
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DATE
NO
0 PLUMBINGIMECH
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (Fl�)
FRONT SIDE HEAR
PROPOSED SETBACKS (FT)
FRONT URSIDE REAR
o COMPLIANCEOR
fALIDITION CHANGE OF USE
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REaD
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NUMBER
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REMARKS
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REQ
PLAN CHECK FEE
HEAT SOURCE GLAZING % LOT SLOPE % BUILDING
TED DATE PLUMBING
PLAN CHECK NO: IVES MECHANICAL
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E AUTHOR SON THE WORKNOTED THISPERMITCOVER WORKTO
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:1 SEPARATE PERMISSION SURCHARGE
PERMIT APILICATI.N:, 181 DAYS
PERMIT LIMIT. 1 YEAR � PROVIDED WORK IMS STA TED ITHIN 180 DAYS EVIEW FEES
SEE BACK OF PINK PERMIT FOR ORE INFORMATION
PPL'CAIMIT�,OANGG E HALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS END. INSPECTION FEE
TO INDE.NIFY Ay�EEEOLNDE) LESS THE CITY F LNANpo�ICAP'NG
IN,,TER R.ES
� �LDEFEND
TSIROM ANYAND __
T OFF` S, E.PL. A = I �T,.N FEE
EDMONDS WASHINGTONSto$W
DIRE
A.AGE F HATEVER NITURE,ARISiNG CTLYORIND-R
ALLCLAIMS FORD T ISS ANCE OF THIS PERMIT SHALL NOT BE PLAN CHECK DIPOIJIT
OF HIS PERMIT U
x FROM THE ISSUANCE -
ANY FANYCtTYOAD]t
5 DEEMED TO MODIFY, WAIVE OR REDUCE REOUIREMENTO
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION,* DUE
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION� THAT THE INFORMATION
OWNER. OR THE DULY AUTHORIZED AGENT OF
GIVEN IS CORRECT, AND THAT I AM THE
THE OWNER. COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL
IAGREETO
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TION IN DOING THE WORK AUTHORIZED THERE Y. N PERSON WILL BE EMPLOYED
'AND " WASHINGTON RELATING TO
THE STAT OF FOR INSPECTION
IN VIOLATION OF THE LABOR CODE OF
WOAKME�LS COMANSATION INSURANCE AND PCW 18.27,
E, (425)
SIGNED
rarAOGNT,
771-0220
_N EXT 333
Af F9FI 0
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX
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ORIGINAL -FILE qELLOW- INSPECTOR
PINK - OWNER GOLD - ASSESSOR
FINAL PROJECT APPROVAL FORM
TO:
DATE-._.
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: DEPARTMENT DATE—
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DESCRIPTION OF WORk,TO BE IN
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A field inspection was condlicteA to determine compliance with approved plans. Final approval denotes that
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there are no objections from the above signed Department to the granting of
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ofthe described work
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Bonds associated with the project may be released
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______yAlLED FINAL INSpE&ON OUTSTANDING ISSUES
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-------RE-INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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RECORD OF INSPECTIONS
INSPECTOR DATE
APPROVED
SETBACK$ .....................
FOUNDATION:
Footing ......................
wall..................
Pier/Porch .............
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Retainirig Wall
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Stab Insulation ..........
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PLUMBING:
underground .............
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EXTERIOR SHEATHING
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NAILING . ..........................
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FRAMING � ........... ...........
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FIRST FLOOR FRAMING
INSULATION ..............
Floor Insulation
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Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
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SPECIAL INSPECTION
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MISCELLANEOUS ..........
FINAL APPROVAL FOR �vj
OCCUPANCY ...........
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RMIT EXPII��S_
CITY OF EDMONDS
... PERMIT I-OOZ57
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CONSTRUCTION PERMIT APPLICATION
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OWNER NAMEMAME OF BUSINESS
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FLAT NAMEISUBDIVIII ION NO.
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REMARKS
OWNERICONTRACTOR FIESPONSIM E —ION
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DESCRIBE WORK TO BE DONE
REMARKS
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PLAN CHECK FEE
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PLAN CHECK NO: 111STIO DATE
MECHANICAL
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS P ERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
RAMNGIFILL
DOMAIN (CURBS, SID S ETC.) WILL REQUIRE
EWALKS, DRIVEWAYS, MA QUEE ,
SEPARATE PERMISSIOM
SURCHARGE
RMIT APPLIC N: 100 DAYS
ATIO
PERMIT LIMIT'. I YEA,, � PROVIDED K SSTARTEDWITHIN 180nAYS
WOR I
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOB MORE INFORMATION
—
UGANT. ON 0 HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
;A
N INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
OFFICIALS, EMPLOYEES, AND AGENTS 'ROM A NYAND
LANDSCAPING
INSPECTION FEE
EDMONDS, WASHINGTON, ITS
ALLCLAIMS FOR DAMAGES OF WHATEVER NATURE, AS ]SING DIRECTLY OR INOMECTLY
RECEIPT/ 05
5
FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SMALL NOT BE
CITY ORIN NANG
PLAN CHECK DEPOSIT
DEEMED To MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY
TO ENFORCE ANY ORDINANCE PROVISION.
RECEIPT
4
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT: HAVE READ THIS APPLICATIOI,L THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT AM THE OWNER, OR THE DULY AUTHORIZED AGENT 01
T'll 11 1 ", , , -
THEOWNEM I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL 81111.1:.11.1 d F P-,
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
WASH, NGTON RELATING TO
I I. �.kl.dg.� -P Pl-vl
FOR INSPECTION
iNVIOL ON OF -THE LABOR CODE OF THE STATE OF
ATI
Y,NSATIONINSURANCE�ANDRCWIB.�27.
WORKMENS COMP
OFFI I S IrNATURE DATE
5 zrl 6D
DATE sl G"ED
(425)
771-0220 BE BY DATE
EXT 333 V c/
Al ION
IT IS UNLAWFUL TO USE OR OCCUPY A 13UILDING OR STRUCTURE UNTIL
_h�
771-0221 1ELL04
FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE INSPECTOR
. ASSESSOR
A
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK - OWNER GOLD
FAX