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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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ERMIT APPLICATION: 10 DAYS
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PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 18D DAYS
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'APPLICANT, ON BEHALF OF His OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS I CITY 01
I T S GO S T N M Y F
EDMONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FR ANYAND
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G S o W VE R ATU E, ARISINGDIRECTLY ONINDIRECTLY
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GIVEN 15 CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THEOWNER I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING C.NSTRoC'
AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOY"
TION: AND IN DO NG THE WORK
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MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE —
ENGINEERING DIVISION DATE —
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PROJECT —
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PERMIT #________________-ADB#_DATE INSPECTED —
DESCRIPTION OF WORK TO BE INSPECTED 61
A field inspection was conducted to determine final compliance with approved plans. Final approval
denotes that there are no objections from the above signed Department to the release of
PE A_NCEBONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GYANT PROJECT APPROVAL WITH CONDITIONS NOTED
XCopy of CONDITIONS given to owner/contractor by inspector
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DESCRIPTION OF WORK TO BE INSPECTE
A field inspection was conducted to determine compliance with approved plans. Final approval denotes that
there are no objections from the above signed Department to the granting of:
Final approval of the described work
GRANT FINAL PROJECT APPROVAL
—GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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—FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATEZ
ENGINEERING DIVISION DATE —
PLANNING DIVISION DATE —
PROJECT
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'71,2_ ADB#_ ATE INSPECTED—
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DESCRIPTION OF WORK TO BE INSPECTED \ ;_ia� - U
A field inspection was conducted to determine final compliance with approved plans. Final approval
denotes that there are no objections from the above signed Department to the release of
PERFOR�MANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
a Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contractor by inspect-
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2. MICROFILM
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date. Sign,
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CMff BULDING OFFICIAL
ITT TIM T ITH 31 I'T's
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ...................... --C2
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wait ..........................
Pler/Porch .................
Retaining Wall 7"
Slab insulation ..........
PLUMBING:
Underground .............
Ro6gh-ln ...................
Commercial Final
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IHEATING:
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Gas Test ..................
Gas Piping .................
Equipment .................
Commercial Final
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING...
INSULA TION
Floor Insulation
Wall Insulation ...........
Calling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
15
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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g. V , WAYS. MARQUEES, ETC.) WILL REQUIRE
'U. S EWALKS, DRIVE
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GRADING'I'LL
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MIT APR C
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PERMIT LIMIT. I YEAR - PROVID A IN ..A,:NNII'D
SEE BACK F PINK PERMIT 0 M A IN RMA':NNIll D
EVIEW FEES
'APPLICANT ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCE15OFS
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD KARMLESS THE CITY OF
ii EMGNDS,W.AS",NGTo" ITFWlliCIAL E."Oylm AN. AGINTEIRONI ANY AND
AULCLAM F RG A.AGE�o HATEVES'NATURIE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALI NOT BE
DEEMED TO MODIFY. WAIVE OR REDUCE AN REQUIREMENT OF ANY CITY ORDINANCE
A N-
NOR LIMIT INNANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE P OVISIO
Y
M. INSPECTION FEE
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PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
I.EREB ACKNOWLEDGE THAT I HAVE READ THIS APPTLIHCEATIOLNY THAT THE INF RNIATION
GIVEN Y OWNER OR OU AUTHORIZED AGENT OF
S CORRECT, AND T AT I AM THE
THEOWIVER. IAGREETOC MP WITH CITY AND STATE LAWS REGUL_ATING CONSTRUC-
TION. ANID IN DOING THE WoORKLAYUTHORIZED THEREBY. NO IERSONTWIL�- B I EMPLOYED
IN VIOLATION OF THE LA A SURANCE ANDRrW�8.27. N. . RELATING TO
WORKMEN S COMPENSATI(.IoN INCODE OF THE STATE OF WASHI
j6WNFA 6PAGENT) DATE SIPNED
CALL
FOR I I NSPECTII
(425)
771-0220
ATTENTION
IT IS UNLAWFUCTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
EXT/333
771-0221
FAX
8
LOAD
PER UBC 1081FINAL INSPECTION
VALUATION I FEE
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Budd,ng Olkial , 'IsMo, CGputy: a�� F.—I. d. .11
provided.
....... DATE
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