20010661.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMENAME OF BUSINESS
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLI C
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SEPARATE PERMISSION.
... ARGE
PERMIT APPLICATION: 1110 DAYS
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PERMIT LIMIT'. I YEAR, PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG, REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENG. INSPECTION FEE
PLICANT. ON BEHALF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESCIRS
�A
N INTEREST. AGREES T �NDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
2 EDMONDS, WASHINGTON. TS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANYAND
ALLCI.ALM.S FOR DAMAGESOF WHATEVER NATURE. ARISING DIRECTLI
INSPECTION FEE
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ALL NOT
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0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE I ROVI SION,�
CEIPI
TOTAL AMOUNT DUE
11
IHEREBY ACKNOWLEDGE THAT I HAVE FIA. THIS APPLICATION. THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
Th,, ppIt,, It A pelmlt 11119-1 by thO
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CDNSTFUC
PERSON WILL BE EMPLOYED
CALL
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TION, AND IN DOING THE WORK AUTH RIZED THEREBY. NO
CODE"OP THE STATE OF WASHINGTON RELATING 7 0
FOR INSPECTION
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IN VIOLATION OF THE LA60R
WORKIVEWS r..PINSAT'i N INSURANCE AND RCW 16.2T
OFFICIA SIG DATE
SIGNA�E (OWNER OF(�Ad DATE SIG ED
(425)
T(RE
I -30
771-0220
-RELEASE
_1W 15�
By
ATTENTION
EXT 1333
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTIL 771-0221
-:�.
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL-KE :_�ELL
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
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FINAL-PRdJECT APP&OVAL FORM
TO: _���V_ C
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE-
-ENGINEERING DIVISION DATE—
�::A� P LANNING DIVISION DAT
SITE ADDR�s�s 2—L I _?50 U
PERMIT # _LZDDATE INSPECTED—
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DESCRIPTION OF WORK TO BE INSPECTED ---a
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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
PERFORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
o Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy ofCORRECTION NOTICE given to owner/contractorby inspector
1.
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall..........................
Pier/Porch
RetainIng Wall ...........
Slab Insulation ..........
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PLUMBING:
Underground .............
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Rough -in ...................
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Commercial Final
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Gas Test ....................
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Gas Piping
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Equipment .................
Commercial Final
EXTERIOR SHEATHING
NAILING..........................
FRAMING .........................
FIRST FLOOR FRAMING
INSULATION ...................
Floor insulation
Wall Insulation ...........
Calling Insulation
SHEETROCK NAILING
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SPECIAL INSPECTION
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
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OCCUPANCY ..............
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DATE RECEIV,
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CONSTRUCTION PERMIT APPLICATION
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2 DOMAIN (CURBS. SIDEWALKS, DRIVE S, MARQUEES. ETC.) WILL R EQUIRE
SEPARATE PERMISSION.
wAy
RMIT APPLICATION: 180 DAYS
P W K IS STARTED WITHIN 180 DAYS
PERMIT LIMIM I YEAR - ROVIDED OR
ENG. REVIEW FEES
SEE BACK 0 PINK PERMIT FOR MORE INFORMATIO
'A PLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
P
WORU
ENO. INSPECTION FEE
REES RMLESS THE CITY OF
IN INTEREST. AG TO ;NDEMNIFY. DEFEND AND HOLD HA
_kNDSCAPING
TON. TS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
2 EDMONDS.WASHING DIR
C ALLCLAIMS FOR DAMAGESOFWHATEVERNATURE.ARISING PE TLYORINDiRECTLY
'm FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS EAMIT,SHALL NOT
INSPECTION FEE
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PLAN CHECK DEPOSIT
IRICEIF
CBE
NY Y
0 EMED TO MODIFY. WAIVE OR REDUCE ANY REOUIREMENTOF AC CT ORDWAN E
9 HE MIT IN ANY. THE CIII'SABILITI TO ENFORCE ANY ORDNANCE PROVISION.-
.
RECEIPT
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THATTHE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT I A. THE OWNER. OR THE DULY AUTHORIZED AGENT OF
A -
THEOWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONST UC
CALL
0-it -.1.1g- by
Suod.19 or fil— D,puty: ,d Foo, p6d. d
00 NG THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EM LOYED
TION: AND IN I P
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
,.
� d.o
r-191 11 ,k-lodged in Bpaw providecim
WORKMEN S COMPENSATION INSURANCE AND RCW 111.27.
OFFICi RE DATE
DATE SIGNED
(425)
3o
771-0220
t DATE
ATTENTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL VILE YELLOW - INISPEJOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX PINK -OWNER GOLD - ASSESSOR