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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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NAME
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NAME
PERMIT EXPIRES
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NUMBER
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ADDRESS 4A—
PLAT NAMEISUBDIVISION NO. LOT NO, U LI NO
LID FEE S
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EXISTING — PROPOSED -
REQUIRED DEDICATION— FT 0
METER SIZE I LINE 1111 NO, OF FIXTURES PRY COUIRED
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REMARKS
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FIRS REVIEWED By DATE
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MECHANICAL
THIS PERMIT AUTHOAIZSS ONU THE WORK NOTED. THIS PERMIT COVERS WORK TO
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DONE ON PRIVATE PROPERTY ONLt ANY CONSTRUCTION ON THE P B
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SEPARATE PERMISSION.
STATE SURCHARGE
PE M IT APPLICATION! 180 DAYS
PERMIT LIMIT. I YEAR � PROVIDED WORK IS STARTED WITHIN 100 DAYS
ENG. R�VIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-It=
'*ft INSPECTION FEE
ON BEHALF OF HIS OR HER SPOUSE, HEIRS. AS$ iGNS AND SUCCESORS
;APPLICANT.
N INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY F
5,
2 EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
ALLCLAIMSFOR DAMAGES OF�WHATEVER NATURE, ARISING DIRECTLYOR INDIRECTLY
,,
m FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT /oo,,,,o,o
i DEEMEOTO MODIFY. WAIVE OR REDUCE ANY REOUIREMENTOF ANY CITY ORDINANCE
'TOTAL
�j NOR LIMIT IN ANY WAYTHE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVE
AMOUNT DUE RECEIF
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
4PPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OR THE DULY AUTHORIZED AGENT OF
OWNER
CONSTRUC-
,I iI igned by
THE OW N2R I AGREE TO COMPLY WITH CITY AN6 STATE LAWS REGULATING
WILL BE EMPLOYED
CALL Idi, � 'I , hi,)h,, Dty: ,d F00—le p. ,d
TION; AND IN DOING THE WORK AUTHORIZED THERESY. No PERSON
IN VIOLATION OF THE LABOR CODE THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION rempt is acknowlodgod �,, P... p—ld.b.
OF
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
0 DATE
SIGNATURE (OZP O&E-NNi SI-111 1
(425)
��ATE
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771-0220 _I_D�
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IIELE 1 A�
ATTENTION 61
EXT/333
IT IS UNLAWFULTO USE OR OCCUPY ASUILDING 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
ORIGINAL - FILE YELLOW - INSPECT R
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FINAL PROJECT APPROVAL FORM
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MEMO TO: PERNUT COORDINATOR, BUILDING DIVISION
ATE
FROM: --FIRE DEPARTMENT D
ENGINEERING DIVISION DATE —
PLANNING DIVISION DATE —
'PROJECT CtfV( 2�,P�c
SITE ADDRESS
pERNUT ...__L_AD]3# ........ DATEINSPECTED—
DESCRIPTION OF WORK TO BE INSPECTEDIL:����,"S�-'�--
al denotes that
'A field inspection was conducted to determine compliance with approved plans. Final approv
there are no objections from the above signed Department to the granting of:
___Final approval ofthe described work
erformance 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 ......................
wait ................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in ...................
Commercial Final
HEATING:
GasTest ....................
Gas Piping .................
Commercial Final
EXTERIOR SHEATHING
NAILING
FRAMING ......................
FIRST FLOOR FRAMING
INSULATION ...............
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
F14AL APPROVAL FOR
OCCUPANCY ..................
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LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS jFT)
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VALUATION
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PLAN CHECK FEE
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HEAT BOURG % LOT SLOPE % BUILDING
PLAN CHECK NO: VESTED DATE
PLUMBING
MECHANICAL
IRIS I ... IT A.I.ORIZES N. THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ON' X ANY CONSTRUCTION ON THE PUBLIC
GRADINGWILL
DOMAIN (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
ESDRCHAAGE
PERMIT A PLICATjON� IBO DAY S
PER IT LjAfT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK 01 PINK IE111IT 1011 MORE INFORMATION
ENG. REVIEW FEES
'AP LICANT. ON BEHALF OF HIS Oil HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
INSPECTION FEE
IN IF DEFEND AND HOLD HARMLESS THE CITY I
NTE EST. AGREES TO INDEMNI FY ANY AND
0. 11,7)
X EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM
Di-- -
A LL CLAIMSFOR DAMAGESOF WHATEVER NATURE, ARISING 11 - 11-
THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT ' If 'Ta 2_,� L/20, =50
FROM CITYORDINANC
is DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENTOF ANY
... .
NOR LIMIT IN ANYWAYTHE CR`YmSABILITY TO ENFORCE ANYORDINMCE IROVISI ON,�
,E�'
RED
TOTALAh .LINT CUP IT
I REFBBI ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN CO RECT, AND THAT I AM THE OWNER, OR ,HE DULy.AUTHGFlNl.EO AGINI OF
IS R r -
TO COMPLY WITH CITY AND 'TAT LAW E.U, GO STRUG
This appj,cbhos 1 b h lig- by IhO
CALL DsP.IV: hd I...
THE OWNER. I AGREE
TION;ANDIN ING THE WORK AUTHORIZED THEREBY, OPERS WiLLBEEMPLOYED
C OF TO
BW,J,�g 014-t .1 111h.1
,,pl is .1k,miodgld ili p,,o pmidedm
FO R INSRECTION
TH LABOR CODE OF THE STATE I WASHION
IN VIOLATION E ON NGTON RELATING
AND RCW 16,27,
WORKMEN'S COMPENSATION INSURANCE
SIGNATURE ""EU
1 (425)
:�EZIG
;�D
771-0220
ATTENTION
EXT1333
IT IS UNLAWFUL TO USE 08 OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APP ROVAL OR A CERTIFI-
OPIGINALmPILE YELLOW- INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109
PINK
FA% OWNER GOLD -ASSESSOR