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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMMAME OF BUSINESS
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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BE ..E ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
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GRADINGIFILL
go"A'. C LABE SIDEWALKS, DRIVEWAYS' MARQUEES, ETC.) WILL REQ
SEPARATE PERMISSION.
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PERMIT APPLICATi sh 181) DAYS
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PRoIND K I STARTED WITHIN 180 DAYS
PERMIT LIMIT. I YEAR � ED WOR
END. REVIEW FEES
A IS
SEE BACK OF PINK PERMIT FO OREINFORMATION
F HIS OR HER SPOUSE. HEIRS. ASStG AND SUCCESORS
A PLICANT. ON BEHAL o:NDEMN11Y. AND HOLD HAR`MSESS THE CITY OF
ENG. INSPECTION FEE
LN '.`T`l.p!NGEE
A�ND
IN INTEREST , AGREES TO DEFEND
TS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANIAND
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2 EDMONDS, WASHING
ToNi OF WHATEVER NATURE. ARISINt
ALLCLAIMSFORDAMAGE
S PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
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FROM THE ISSUANCE OF THIS PERMIT. ISE ANoCEAo.F EXT' OF ANY CITY ORDINANCE
DEEMEDToMODIFY� WAIVE OR REDUCE A YR YORDINANCEP OVISIQN.'
ANY ORDINANCE P
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TOTAL .....T DUE
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I HEREBY ACKNOW EDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFORMATION
APPCICATION APPROVAL
GI EN IS CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
REGULATING CONSTRUC
CALL
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THEO NER I AGREE TO COMPLY WITH CITY AND STATE LAWS
No PEASE, N WILL BE EMPLOYED
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Depuly and Fall 11, p1lb. and
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ION. AWID IN 1101 NG TH E WORK AUT..A2ED TH'
THE STATE OF WASHINGTON A j LATING To
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FOR INSPECTION
IN VIOLATION OF THE LABOR CODE OF
WORKMENSCO P N SURANCE AND FEW 18 27
OF IA S SIGNATURE
DATE
SIGNATURE,�NERZViENT1 D E SIGNED
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77-1-0220
RELEASED By
EXT 1333
ATtENTION
IS UNLAWFUL TO USE 08 OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
IT
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL-
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CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
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- GOLD - ASSESSOR
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FINAL PROJECT APPROVAL FORM
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DATE: 2-
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MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE —
ENGINEERING DIVISION DATE —
PLANNING DIVISION DATE-- "1'81
PROJECT WA /A�
I / -
SITE ADDRESS
PERMIT #Q% ADB# DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPEC �—M2 —41�
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
pERFO—RMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy ofCONDMONS given to owner/contractorby inspector
1.
F41LED FINAL INSPECTION - OUTSTANDING ISSUES
Copy of CORRECHON NOTICE given to owner/contractor by inspector
2.
3.
RE-INSpECTED OUTSTANDING ISSUES - GRANT ]NAL PROJECT APPROVAL
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TINAL PROJECT APPROVAL FORM
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MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE -
ENGINEERING DIVISION DATE_
DATE
—PLANNING DIVISION
PROJEC
SITE ADDRESS
PERMIT #_2_0_Q_L_QH_'Y —/--ADB#-42/— LZDATE INSPECTED —
DESCRIPTION OF WORK TO BEINSPECTED
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
PERFO CE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITTI CONDITIONS NOTED
(3 Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
Ix Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE-INSPECT41) OUTSTANDING ISSUES - GRANT FINAL PROWT APPROVAL
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DATE:—i�
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE�—
ENGINEERING DIVISION DATE —
PLANNING DIVISION DATE
PERMIT g5�*X'
--AD]3#_DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED
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 WnH CONDITIONS NOTED
o Copy of CONDITIONS given to owner/contractor by inspector
1.
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
c3 Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE-INSP)ECTED OUTSTANDING ISSUES - GRANT FINAL PRoiggr APPROVAL
Date (0/- 7 1c, - Si
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
IIETBACKS
.....................
FOUNDATION:
Footing .......................
wall..........................
Pier/Porch .................
Retaining Wall
Slab Insulation ..........
V,
PLUMBING:
Underground .............
CA
C3 m
Rough -in ...................
m
Cornmercial Final
HEATING:
Gas Test ....................
Gas Piping .................
�Equli`ment 7`7 ..........
0 -n
CommeTclil Final
EXTERIOR SHEATHING
mm
NAILING ..........................
FRAMING ........................
FIRET'FLOOR FRAMING
ic
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Calling Insulation
IiHEETROCK NAILING
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SPECIAL INSPECTION
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ...................
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PERMIT LIMIT. I YEAR P W RK IS STARTED WITHIN 180 DAYS
-M T IT I YEAR
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OI;PROVIOEDffO
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TOTAL AMOUNT UE
ACKNOWLEDGE THAT I HAVE READ THIS AIPPTLIMC5ATIUOLN4 THAT HEINFORMATION
APPLICATI N APPROVAL
I HEREBY
A I AM THE OWNER 0 AUTHORIZED AGENT OF
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"YEN IS C.R."C'EAN.
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.IN. THE OF K AUTHORIZED THEREBY. NO PERSON YALL
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FOR INSPECTION
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IN ,GLAT, N 0 T. ... E .1 THE STATE
WORKMEN S COMPENSATI SURANCE AND RCW 16.27.
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(425)
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771-0220
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RELEASED B
EXT 1333
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A ION
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TO USE OR OCCUPY A BUILDING OR STRUCTURE
YELL.W INSPi1TO X
IT IS UNLAWFUL
HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - WE
GOLD - ASSESSOR
A FINAL INSPECTION
HAS BEEN GRANTED. UBC SECTION 109
FA x
PINK - OWNER
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