20010667.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ERNAMIDHAME OF BUSINESS
CITY 11P IELEF ... E
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NAME
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JOB SUIT T
ADDRESS
FLA NAMEISUBDIVISLON NO, LOT NO,
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REMARKS
PROGRESS INSPECTIO!!S PER UBC 108/FINAL INSPECTION REO'
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THIS PERMIT AUTHORIZES ON' Y THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLI C
GRADING/FILL
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DOMAIN (CURBS. SIDEWALKS. DRIVEWAYS. MARQUEES, ETC.) WILL ED IRE
SEPARATE PERMISSION.
A.GE
PERMIT APPLICATION: 1.0 DAYS
PERMIT LIMIT'. I YEAR PROVIDED WOR HIS STA TED WITHIN 180 DAYS
ENG. REVIEW FEES
M
SEE BACK 01� PINK PERMIT FO ORERNFORMATION
ENG. INSPECTION FEE
OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
N, 'o,H.E..Il DEFEND A.. OLD HARMLESS THE CITY 05
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FROM ANYAND
LANDSCAPING
12 EDMONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS
51 ALLCL,UMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
INSPECTION FEE
RECEIPT
il FROM THE ISSUANCE or THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
cil DEEMED TO MODIFY. WAIVE OR REDUCEANY REOUIREMENTOFANY CITYORGINANCE
TO ENFORCE ANYOROINANCE PROVISION""
REC
51 NOR LIMIT IN ANYWAYTHE CITY'S ABILITY
TOTAL AIVIOUNT DUE
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IHEREBY ACKNOWLEDGE THAT I HAVE FEA. lIUS APPLICATION; THAT THE INF RMATION
APPLICATI N APPROVAL
GIVEN I S CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THEOWNER IAGREE To COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
CALL
B�,ld�g offic,al 11 hill- D �d F111 — PlId
TION. AND IN DOING THE WORK AUTHORIZED THEREBY, NG PERSON WILL BE EMPLOYED
ELATING TO
FOR INSPECTION
d,p.ty:
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON
WORKMEN 5��GN INSURANCE AND RCW 16.27
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IT IS U�LAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL -FILE YELLOW -INSPECT R
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
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PINK - OWNER GOLD - ASSESSOR
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MICROFILM
FINAL PROJECT APPROVAL FORM-
TO:-
DATE:-
NIEMO TO: PERmrr COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE-
(����GINEERING DIVISION DATE,3_JLS�
PLANNING DIVISION DATE -
PROJECT
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INSPECTED
PERMIT #
DESCRIPTION OF WORK TO BE INSPEC
A field inspection was conducted to determine final COMPHRnce with approved plans. Final approval.
denotes that there are no objections from the above signed Department to the release of
and the granting of:
FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
u Copy of CONDITIONS given to owner/contractor by inspector
1.
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date. Sign__,
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS
FOUNDATION:
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wall ..........................
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Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
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PLUMBING:
Underground .............
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Rough -in ...................
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Commercial Final
HEATING:
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Gas Test .............
Gas Piping .................
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Equipment .................
Commercial Final
EXTERIOR SHEATHING
NAILING ...................
FRAMING ........................
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
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Wall Insulation ...........
Ceiling insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR ttv"is
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�'-FPERMIT EXPIRES
us PERMIT e2��
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CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB
ADDRESS
PLATNAME/SUBDiVIStONN
LOT NO.
LID NO.
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MAIUNG ADDRFAS
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NAME
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ADDRESS
REMARKS
WNE.CONTRA.TOPt RESPONSIBLE FOR EROSION CONTROLIDPAINAGE
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SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
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PROPERTY TAX ACCOUNT PARCEL NO.
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ALLOWED PROPOSED
FRONT SIDE REAR
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0 ADDITION E:] COMMERCIAL
o COMPLIANCE OR
CHANGE OF USE
PARKING LOTAREA LANNING REVtEO BY DATE
REMODEL 0 APARTMENT
SIGN
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0 REPAIR 0 RA.W. Cy.. ',EA� X F,
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REMARKS
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THIS PERMIT AUTHORIZE IS PERMIT COVERS WORK TO
t: BE DONE ON PRIVAT ONLY. ANY CoNSTRUCTM,0,,N'THE PUBLIC
E PROPER7
GRADINGIFILL
EE
2 DOMAIN (CURBS. SIDEWALKS DRIVEWAYS- MAROU LLREO IRE
SEPARATE PERMISSION.
�AVX&SURCHARGE
PERMIT APPLICATION: 160 DAYS
W
PERMIT UNIT. i YEAR - PROVIDED ORK 15 STARTED WITHM
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENG. RE.YIEW FEES
ON BEHALF OF HI OR HER SPOUSE. HEIRS. ASSIGNS AN DSUCCESORS
ENG. INSPECTION FEE
I.
3
;APPLICANT.
NINIEEIT.Al I'S *�NDEMNIFYDEF END AND HOLD HARMLESS THE CITY OF
ANY AND
ON
LANDSCAPING
2
,NGT TS OFF CIALS, EMPLOYEES. AND AGENTS FROM
EDV.ND�' WA..R
ALLCLAIMS FOR DAMAGESOF WHATEVER NATURE. ARISING DIRECTLYOR INDIRECTLY
114SPECTION FEE
M
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
9
OEEMEDTO MODIFY. WAIVE OR REDUC E ANY REOUIREMENTOF ANYCITY ORDII, NCE
ANY ORDINA14CE PROVISION,
REC
0
N OR LIMIT IN ANY WAY THE CITY�S ABILITY TO ENFORCE
TOTAL AMOUNT DUE
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IHERE'Y AQ�NCWLE DGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
T A p,,.,[ il 11911d by thS
THE OWNER, JAGREE To COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
CALL
Bu,d, O"_ O.,Iy; ld F... F.d.
0
TION: AND IN DOING THE WORK AUTHORIZED THEREBY, N IERSONWILLSEEMPLO�fED
ELATING TO
FOR INSPECTION
.1
OF
IN VIOLATION OF THE LABOR CODE THE STATE OF WASHINGTON
ATE
WORKMEN S TION NSURANCE AND RCWIS.27.
1
(425)
— T)
li�w !7
E SIGNED
7�
771-0220
P,
EXT 1333
A'ftENfIO_N.
IT IS UNCA'WFUL TO USE 08 OCCUPY A BUILDING OR STRUCTURE LINT
L 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI.
ORIGINAL -FILE YELLOW -INSPECTOR
PINK - OWNER GOLD - ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. U.0 SECTION 109
FAX