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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSI�ESS
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CITY ZIP TELEPHONE
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OFFOR
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NO. OF FIXTURES
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YES 0 NO 0
REMARKS
OUD.
RESPONSIBLE EROSION CONTROUDRAINAGE
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DATE
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NUMBER �j.71. 1��PECT7iA LOAD
OF DWELLING PEAS SEGUHRED C] YES OCCUPANT
STORIES UNITS NUMBER
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DESCRIBE WORK TO BE DONE REMARKS
PROGRESS INSPECTIONS PER USC 108/FINAL INSPECTION
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VALUATION I FEE
PLANCHECKFEE
LOT SLOPE I
0
HEAT SOURCE
BUILDING
PLAN CHECK NO:
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZE$ ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
DOMAIN (CURBS. SIDEWALKS. DRIVEWAYS, MI ETC.) WILL REQUIRE
3 SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT APPLICATION: 1.� DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN i8D DAYS
ENG REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORM ION
ON BEHALF OF HIS OR HER SPOUSE. 1@11. AAFIDNs AND SUCCESORS
;APPLICANT.
N INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMI ESS THE CITY OF
LANDSCA G
P ... 1— IT.I.IIICIALS.EMILOYEES, AND AGENTS FROM ANYAND
INSPECTION FEE
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RECEIPT
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RDINANCE PROVISION,'
PLAN CHECK
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uki
TOTAL AMOUNT DUE
I HEREBY ACKNOW EDGE THAT: HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT AM THE OWNER, OR THE DULY AUTHORIZED AGENT 01
Th,l pplbal— , 1 b ll,ld by th.
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
ED
CALL
B,119 011-clal .1 b— ..P.Ivl b, F_ I. 'AP.
TION� AN D IN DOING THE WORK AUTHORIZED TH E REBY. NO IE RSON WILL BE EMPLOY
OF WASHINGTON RELATING TO
FOR INSPECTION
.pI I I .1k,.wi,dgld In space povided.
IN VIOLATION OF THE LABOR CODE OF THE STATE
"MPEN�P51QM2�,211AN�F AND FCW 1..�T' I
FICIALS SIG�R
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rATE
771-0220
FI�EASFD BY 'DATt
EXT 333
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BU LDI NG OR STRUCTURE UNTIL
771-0221
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL -FILE - YELLOW- INSPECTOR
A FINAL
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK OWNER - GOLD -ASSESSOR
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DATE:
N[EM0 TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: _FIRE DFPARTI�MNT D
ENGINEERING DIVISION DATE —
PLANNING DIVISION DATE —
PROJECT Atc, (�(&A41 Z
4-4
SITE ADDRESS 6
PERIM #
INSPECTED-2::L
DESCRIPTION OF WORK TO BE INSPECTED
approved plans. Final approval denotes that
A field inspection was conducted to determine compliance with
there are no objections from the above signed Department to the granting of:
X, inal approval of the described work
rmance Bonds associated with the project may be released
_—,Z,—GRANT FINAL PROJECT APPROVAL
--GRANT FINAL PROJECT APPROVAL WITH CONDITIONS NOTED
I
_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
SETBACK$ .....................
FOUNDATION:
Footing ......................
wall ..........................
Pier/PoTch .................
Retainirig 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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LID FEE S
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(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN.
NUMBER NUM11ROF 11111CAL
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DESCRIBE WORK TO BE DONE
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVER I WORK TO
BE ONE . PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
A. (CLIFI.S. DRIVEWAY MARQUEES. ETC.) WILL REOUIRE
SIDEWALKS, S'
SEPARATE PERMISSION.
STATE SURCHARGE
E MIT APPLICATION: 10 DAYS
P R
PERMIT LIMIM I YEAR, PROVIDED WORK IS STARTED WITHIN 18D DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ON BEHAL OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
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;APPLICANT
, INTCRE ST, AGREES TO :NDEMNIFY, DEF NO AND HOLD HARMLESS THE CITY OF
LANDSCA G
EDMONDS. WASHINGTON. TS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
ALLCLAIMS FOR DAMAGES OF WHATEVER NATURE.ARISING DIRECTLY OR INDIRECTLY
INSPECTION FEE
RECEIPT
m
a
,
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT, SHALL NOT BE
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF AN, C Ty FGIN�NCE
PROVISION.'
PLAN CHECK DEPOSIT
R
0
NOR UM[ T IN ANY WAY THE MTY'!5 ABILITY TO E NIORCE ANY ORDNANCE
TOTAL AMOUNT DUE
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IHERE YACKNOWLEDGETHAT�H E READ THIS APPLICATION: THAT THE INFORMATION
a AV
CATION PIPROVAL
PL, !
GIVEN I S CORRECT. AND THAT AM THE OWNER. OR THE DULY AUTHORIZED AGENTOF
T�7`- - I. I
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC -
LOYE
CALL
Bul I 1"I, — 111, all lid, .�d
1HE Y. No P5ssq, WILL
TION. AND,IN GONG THEWORK AUTHORIZED TH OF GT.N BI'LLEAMTPING To
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FOR INSPECTIO
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IN VIOLAT ON O'F THE LABOR CODE OF THE STATEo
WORKMEN'S_�CIMPWATION INSURANCE AND FqW IB.27.
�FICIALS SIGNATU ATE
6 OR AGEN�
ATE S' E
T,
(425)
I
771-0220
RE�EASED BY
EXT 333
AltENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTI
771-0221
HAS BEEN MADE AND APPROVAL OR A CERTIF
ORIGINAL FILE YELLOW INSPECT R
A FINAL INSPECTION
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION,109
FAX
PINK OWNER GOLD - ASSESSOR
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