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PERMIT EXPIRES
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CITY OF EDMONDS
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CONSTRUCTION PERMIT APPUCATION 'AOGRESS
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OWNER NAMEMAME OF BUSINESS
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PLAT NAMEISUBDIVISION NO. LOT NO,
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MAILING ADDRESS
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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CITY
EXISTING — PROPOSED
REQUIRED DEDICATION— FT
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NAME
METER -size LINISU
PAV REQUIRED
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YES C3 NO 0
ADDRESS
REMARKS
NERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
OWNER"
ZIP
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ADDRESS "li ,
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STATE LICENSE NUMBER ,7;RATION DATE
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COMPLETE EXEN
EXP I
0 NEW t�-AVEIDENTIAL PIUMSIN- I MEC-
T RI
COVE
LOW C-VERM
LOW
Al " ED PIT
0
0 A DITION
o C MPIAANCE OR
APR
r
CHANGE OF USE
0 REMODEL
0 SIGN
PARKING
REG"D I PROVIDE]
0 REPAIR
0 GRADING CYGS 0 FENCE
I X Fn
REMARKS
0 DEMOLISH
0 TANK
0 OTHER
oGARAGE
CARPORT
o RETAINING WALL
ROOKERY 0 RENEWAL
OWE OF USE, BUSINESS
OR ACT
7—T-RUMBER
OF
OF
. ELLIN.
CRITICAL
AREAS
SPECIAL NSPECTOI
STORIES
UNITS
NUMBER
a EQUIREDO YES
DESCRIBE WORK TO BE DONE
REMARKS
71
E
PROGRESS INS
VAWATION $
Deacricillon I F;E
INSPECTION 'ONO
'Y.E.& STE.
ES G
ALLOW
IMD SETBACKS (IFT)
jQW_RRSIDE REAR
GROUP ��
OCCUPANT
LOAD
INSPECTION REO'D
FEE
HEAT SOURCE OWING %
LOT SLOPE %
Building
PLAN CHECK NO:
VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZED ONLY THE ORK NOTED. THIS PERMIT COVERS WORK TO]
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
Recording Fee
2 REQUIRE
DOMAIN JCURSS. SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL BIDS
SEPARJUrEPERMISSION.
Engr. Review
City Surcharge
PE MRIAPPLICATION: 1180DAYS
PEAMITUMMIYEALR-PROVI ED WORK IS STARTED WITHIN IMIDAYS
Engrinspection
State Surcharge
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF His OR HER SPOUSE. HEIRS. ASSIGNS AND EU .. Sons
SUCCESORS
Plan Chk Deposit
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
11
EDMONDS, IHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS 110 ANY AND
WA
Fire Review
V
Receipt IS
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY 09 INDIRECTLY
I
NOT 0
kTrafficMitigation
FROM THE ISSUA CE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL
To CE
C
DEEMED MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINAN E
Fire Inspection
PH I so"
Total Amount Due
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
andscapeinsp.
L L. a P. a.
Receipt #
'.aT T.. r � A
I HERE ACKNOWLEDGE 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
THE OWNER. IAGRE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC_
CALL
This application Is not a paterst,atif.1griod by Uni
TION; AND IN DOING TH WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Bussing Official d'hisf "Do"c":
h' and Fees are paid, a
—nip'l—k—ledgel 1-parop—Ided.
WORKMENS COMPENSATION,=RANCE AND HOW tS.27. a
OFFIC a DATE
SIGNATURE (OWNER 941 AGIE
DATE SIGNED
(425)
;7TUHE
RELEASED BY U
ATTEWrION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING 08 STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE - YELLOW . INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER - GOLD � ASSESSOR
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
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ENGINEERING DIVISION DATE—�2�
PLANNING DIVISION DATE —
PROJECT siaw
SITE ADDRESS IMM Wayood
PERMIT # 2 00'Z — 00-7 3 ADBk--DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED—W
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
u Copy of CONDITIONS given to owner/contractor by inspector
1.
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
a 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:
Footing ......................
wall
Pier/Porch .................
z
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground ............
0 pri
Rough -in
C 0
............
M
0
Commercial Final
0
C
HEATING:
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ID z
to —1
Gas Test ....................
C
>
Gas Piping .................
Equipment .................
O"n
-D
Commercial Final
-4
:E
M ITI
EXTERIOR SHEATHING
a
NAILING ............ .............
0
0
FRAMING ..........
C
9 0)
0
FIRST FLOOR FRAMING.-
z
7-1
INSULATION ...................
Floor Insulation
z
Wall Insulation ...........
-4
p
Coiling Insulation
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SHEETROCK NAILING
SPECIAL INSPECTION
M
MISCELLANEOUS
FINAL APPROVAL FOR
OCCUPANCY ........... . .....