20000461.pdfCITY OF EDMONDS'
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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MAILING ADDRESS
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CITY ZIP IT11EP" NE
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NAME
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LID FEE I
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REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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9 E DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE lU 5LIC
GRADINGIFILL
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
I ESURCHARGE
9 RMIT APPLICATION: 180 DAYS
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PERMIT LIMIT. I YEAR � ROVIDED WOR 15 STARTED WITHIN 180 DAYS
ENG, REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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PLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIPS, ASSIGNS AND SUCCESORS
�AP
N INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAP
EDMON,%WASRIA.G�T�N TF.IFFIIKE�ALI. EMPLOYS., AND AGENTS FROM ANY AND
NSPECTION FEE
,I ALLC". FOR BIG AT E. NATURE, ARISING DIRECTLYOR INDIRECTLY
ERMIT SHALL NOT BE
ANCE OF THIS
I FROM THE '=��Y�,E OF T-INPE`�Z`Cl NY UEOUIREMENT OPANY CITY ORDINANCE
,EMEGTG WAVF. E A'E-R
PLAN CHECK DEPOSIT
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY OHUIN
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT, AND T AT I AM THE OWNER, OR THE DUI-Y AUTHORIZE. AGENT OF
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THEOWNER. I AGREE TO CHMPLY WIT. CITY AND 'TAT' L.AWS nEGULATINGCONSTRUC
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EMPLOYEE
TiON, AND IN DOING THE WORK AUTHORIZED TRER�By� N PERSON WILL BE L
OF WASHINGTON RE ATIi,IG TO
FOR INSPECTION
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IN VIOLATION OF THE LABOR CODE OF THE STATE
.OPKMEN�S COMPENSATION INSURANCE AND RCW 18.21,
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(425)
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SIC VUd tNFJIJ�� OAT SIGNED
771-0220
ELF SED
AlVENTION
EXT 333
ITIS UNLAWFULTOUSEOR OCCUPY A BUILDING OR STRUCTUREUNTIL
771-0221
NAL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFk
ORIGI - FILE ELLOW - INSPE TOR
cATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109
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LANNING DIVISION DATE
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PERmrr# Qcic��t4tn� . ... .... _ADB#_________DATE INSPECTED-
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DESCRIPTION OF WORK TO BE INSPEC
ermine c mpli ce with approved plans. Final approval denotes that
A field inspection was conducted to det o an
there are no objections from the above signed Depariment to the granting of:
--4,,Yinal approval ofthe described work
performance Bonds associated with the project may be released
-GRANT FINAL PROJECT APPROVAL
-GRANT FINAL PROJECT APPROVAL WITH CONDITIONS NOTED
---FAILED FINAL INSPECTION - OUTSTANDING ISSUES
2.
3.
______RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS
FOUNDATION:
Footing ......................
wall ..........................
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Pier/Porch .................
Retaintrig Wall ...........
Slab Insulation ..........
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PLUMBING:
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Rough -In ...................
Commercial Final
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Gas Test ................
Gas Piping .................
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Equipment ...........
1711 M,
commercial Final
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EXTERIOR SHEATHING
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FRAMING ..............
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FIRST FLOOR FRAMING
INSULATION ................ —
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Floor Insulation
Wall insulation ...........
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Ceiling Insulation
SHEETROCK NAILING
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SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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OAT A CTED
CITY OF EDMONDS'
I
CONSTRUCTION PERMIT APPLICATION`——
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REQUIRED DEDICATION—
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PRY REQUIRED
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ADDRESS
EMARKS
0 NERICONTRACTOR RESPONSIBLE CONTROUDRAINA—
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BOND
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STATE LICENSE NUMBER
AM& Ir a P14 2, V S 4- "
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1-1 ACCOUNT PARCEL NO�
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R RIESS INSPECTIONS PER UBC 10811FI.ALI.SpiCTION REO'D
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HEAT SOURCE LOT SLOPS I
BUILDING
ED DATE
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PLUMBING
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTE37 W.IT COVERS WORK 70
BE DONE ON PRIV PU UC
ATE PROPERTY ONLY. ANY 0075TIRNA TC WINUOUIRE
SIDEWALKS, DRIVEWAYS, MARQUEES, E I
GRADINGIFILL
DOMAIN (CURBS.
SEPARATE PERMISSION.
t
STATE SURCHARGE
PE?MITAPpLICATION: 180DAYS
I YEAR PROVIDED WORK IS STARTED WITHIN 180 DAYS
END REVIEW FEES
PERMIT LIMIT.
SEE BACK OF PINK PER41T FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. A SI NS AN SU ES PIS
T E ITY F
NNTERESWT.=T.TO N.Do,.NIFY. 1IEl.G AND H.LD AR LESS
N. ;T " CIALS, EMPLOYEES. AND A ENTSF A YAN
INSPECTION FEE
EDMONDS, IN
AULCLAIMS FOR DAMAGESOFWHATEVER NATURE,ARISING IRE LY IRS TLY
OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
FROM THE ISSUANCE
DEEMEDTOMODIFY,WAIVEOR REDUCE ANY REQUIREMENTOF ANY CITY ORDINANCE
PROVISION.'
o OR LIMIT IN ANY WAY THE CII Y'S ABILITY TO ENFORCE ANY ORDINA14CE
N
TOTAL AMOUNT DUE
I HERE y Is
8 B =T.,lAN5.E T.HATT: AHAIS F EA 1) TH AIPLI ..0 N. THAT TH E I NFORMAT 10 N
GIVEN . HE OWNER, OR THE OULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC�
NO PERSON WILL BE EMPLOYED
CALL
TJON� AND IN DOING THE WCRK AOUTDHORIZ D HEREBY.
SOPS T
IN VIOLATION OF THE LABOR C THE STATE OF WASHINGTON RELATING TO
-R INSPECT[,
FO
WORKMEN,, COMPENSATION INSURANCE AND IICW 11,11,
SIGNED
(425)
tT) E
— / I I j - 2"d -
771-0220
;4
EXT 333
AIVENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS 13EEN MADE AND APPROVAL 08 A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
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