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CITY OF EDMONDS
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INSPECTION BOND
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SEPA REVIEW
COMPLETE EXEMPT ALLOWED pqOPO 0 ALLOWED PROPOSED
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PROPERTY TAX ACCOUNT PARCEL NO.
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ALL LOED PROPOSED FRON SIDE BEAR FRONT UPSIDE REAFT)
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COMMERCIAL C] COMPLIANGEOR
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C3 ADDITION x CHANGE OF USE
P KING LOTAREA PLANNING REVIEWED By
0 FkEMODEL 0 APARTMENT C3 SIGN
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EMARKS
0 DEMOLISH [3 TANK
CARPORT 0 11TlAK'NlIjV` WALL
0 GARAGE BE N 0
(TYPE OF USE, BUSINESS 08 ACTIVITY) EXPILAIN!
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NUMBER
NUMBER OF
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SPECIAL INSPECTOR
OCCUPANT
LOAD
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DWELLING
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NUMBER
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REQUIRED 0 YES
DESCRIBE WORK TO BE DONE
REMARKS ER UBC 1081FINAL INSPECTION REC'D
PROGRESS INSPECTIONS P
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VALUATION
FEE
PLAN CHECK FEE
HEAT SOURCE GLAZING % LOTSLOP %
BUILDING
PLAN CHECK NO:
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PLUMBING
ECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
HE DONE ON PRIVATE PROPERTY ONLY� ANY CONSTRUCTION ON THE PUBLIC
GRAGING/rILL
DOMAIN JCURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC,) WILL REQUIRE
:I SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT APPLICATION; 180 DAYS
PERMIT LIMIT, I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG REWEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF Hl OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO :NDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
ENG. INSPECTION FEE
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—.1-TON. T FFICIALS, ",LOyEE, NO AGEECTTLIYI�ROM ANY AN.
S
0HATEVER 'N.C, 'DIRECTLY
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S PERMIT SHALL NOT BE
PLAN CHECK DEPO IT
OFANY CITYORDINANCE
ORDINANCE PROVISION.-
RE IP�.. slo
OTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIOLN� THAT THE INIOSMATION
OF
Ap ICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER. OR THE DUS AUTHORIZED AGENT
I AGREE TO COMPLY WITH CITY AND STATE LAW REGULATING ONSTRUC
T1,11111.11- �� nN - P"Pa' 'a"' "gand ay
CALL 5111dIn Olf,Nald, hi,lh,, D,p,ly: and Fall- p,,d,,nd
THEOWNER,
TION: AND IN 0001�NG TEII AUT ORIZED THEREBY� NO PERSON WILL BE EMPLOYED
RELATING TO
F . OR INSPECTION topt o a-dalld9ld 'a aplll p.1d,d,
W I TH '0 He STATE OF WASHING10N
IN L. ON L=r ,HE OF T
DATE
WORKMEN., COMPENSATION INSURANCE AND RCW 16.27�
OFFIC SI Ik.TURE
OFF'c s'
(425)
ENT
X771-0220(
LEASED 81 DATE
EXT 333
ATTENAON
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFt-
ORIGINAL FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX PINK - OWNER GOLD - ASSESSOR
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RECORD OF INSPECTIONS
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DATE APPROVED
SETBACKS .....................
FOUNDATION:
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Footing ....................
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HEATING:
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Gas Test
Ga. Pi iping ...........
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Equipment
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cornmecial Final
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EXTERIOR SHEATHING
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NAILING ..........................
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FRAMING .....................
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FIRST FLOOR FRAMING
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INSULATION ...........
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Floor Insulation
Wall Insulation ..........
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Ceiling Insulation
SHEETROCK NAILING
IR
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ... ..............
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PERMITEXPIR
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NUMBER
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CHANGE OF USE
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DEMOLISH 5t
C2_TANK
GARAGE RETAINING LL C]
CARPORT C3 ROOKERY
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FlI.)
FRONT SIDE REAR
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PONT LeR E
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STORIES
11
SEECIAL�1.11 0'.
EGG R E YET
OCCUPAN.
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
NS PER UBC 108/FINAL INSPECTION REO'D
BESS INSPECTIO,,
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HEAT SOU RCE GILAIING % LOT SLOPE I BUILDING z
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MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THSUpE.M,,,T.ColHEEl"l&0RK TO
8,.00INlGNlItlVATr PROPERTY NLYA.lC.NST G TIT.. N U. (31ACIN.11111,
DO N CURB SIDEWALKS, DRIVEWAY% MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION-
t: STATE SURCHARGE
PE MITOAPFELDICWATIR,�� 0 DAYS
PERMIT LIMIT. I YEARR PIT VIC 0 1 TAsTEbIIfITHIN ISODAYS fNal REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER,,SPOUSE, HEIRS. A SIGNS AND SUCCESORS END, INSPECTION FEE
IN TMITIST, AGREES TO NGEMNIFY, �D �NHDEIHR R�D SS THE CITY .1 -t`A4,G s-.
!T OF TE
OB D' C=L ANYAND IN IF
2 EDMON WASHINGTON. FICIALS. B.IL.YE.. A S ROM E
ALLCLaIMSFOR DAMAGES OFWHATEVER NATURE. ARISING DIRECTLYOR INDIRECTLY RECEIPT
FROM T14E ISSUANC OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE - PLAN CHECK DEPOSIT J r)
OCEMEDTO MODIFY, WAIVE OR REDUCE ANY R IREMENTOFANYCITYORDINANCC RE
0 NOR LIMIT IN ANYWAYTHE CITY�SABIUTY TO EEoFQURCE ANY ORDINANCE PROVISION.'.
ac TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE IT EAD THIS APPLICATION; THAT THE INFORMATION AP ICATION APPROVAL
AUTHOR ZED AGENT db
GIVET�WS CORRECT, AND THAT I AM THE OWNER, OR, THE DULY LATIN. IONBTFuoc'
a'a �d—e
THE 6 NER. I AGREE To COMPLY WITH CITY AND ST' E LAWSFE.0 CALL Blddil0Off,,,.IllhIllhll oputy:andFoos 0
TION; AND IN DOING THE WORK AUTHORIZED TMER"a Y,N PERSON WILL BE EMPLOYED
E OFOWASHINGTON RELATING TO R INSPECTION Ppjjk ... Idgad 11 apace proviced.
IN VIOLATION OF THE LABOR CODE OF THE STAT FO DATE
WORKMEN'S COMPENSATION INSURANCE AND ROW 18,27, OFFIC I SIG A
(425)NED
117E OWN MAGEA�T/ 800
0 70012A 771-0220 LEAIEDBY DATE
A A ENT ON EXT 333 C�
TTENT ON
TIS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221 ORIGINAL 51LE YELLOW- INSPECTOR
'A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
C SECTION 109
CATE OF OCCUPANCY HAS BEEN GRANTED. US FAX PINK - OWNER GOLD, ASSESSOR