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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION FACOURESS
PLAT NAMNSUBDIVISION NO.
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PUBLIC RIGHT OF WAY PER OFFICI,
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REQUIRED DEDICATION- FT
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NO. 01 FInURES
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YES [3 NO E3
REMARKS
OWNEFVCONTRACTOR RESPONSIBLE FOR EROSION CONTAOLIGFUMNA.E
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STATE LICENSE NUMBER EXPIRATION DATE
VARIANCE OR CU
SHORELINE OR ADS#
SHORE
INSPECTION
REO'D
PBOND
OSTED
'4
17
E3 YES E3 NO
SEPA REVIEW
COMPLETE EXEMPT
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LOW PROPOSED
ALLOWED
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ALLOWED 8
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PROPOSED SETBACKS (FT.)
FRONT URSIDE HEAR
ADDITION 1:1 COMMERCIAL o COMPLIAN E OR
CHANGE Or USE
[:I REMODEL 0 APARTMENT Ej SIGN
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PARKING
Repo I PROVIDED
LOT AREA
PLANNING REVIEWED By DATE
13 REPAIR [3 GRADING CYOR 0 F NCE
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DEMOLISH TANK OTHER
[3 GARAGE RETAINING
CARPORT 0 ROOKERY WALL RENEWAL
(TYPE OF USE, SUSINEER ACTIVITY) EXPLAIN:
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DESCRIBE WORK TO BE DONE
REMARKS
OGRESS INSPECTIONS PER UIBC 108/FINAL INSPECTION REO'D
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Plan Check
HEAT SOURCE GLAZING I LOT SLOPE I
Building
PLAN CHECK VIRLID DATE
Plumbing
Mechanical
THISPERIN AUTHORIZES ONLYTHE WORK NOTED. THIS PERMIT COVERS WORKTO
BE DONE ON PRIVATE PROPERTY ONLY. A. CONSTRUCTION ON THE PUBLIC
Grading
DONIAIN (CURDS, SIDENALKS. DRIVEWAYS ... a., ) WILL REQUIRE
3 ..F.T. P. GISM520 No
----
Engr. Review
PER ITAPPLICATiON: IN DAYS
PERMITUM I YEAR � PROVIDED WORK IS STARTED WITHIN INDAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRSLASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND NO D HARMLE S THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, MD AGENTS Moll ANY AND
Fire Review
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE Of THIS PERMIT. ISSUANCi OF THIS PERMIT SHALL NOT HE
DEEMED To MODIFYWAIVE On REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Fire Inspection
NOR LIMIT IN AM W Y THE CIIYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
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I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
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GIVEN IS CORRECT AND THAT I AM THE OWMEFT OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGRE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC'
CALL
TION, AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
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WORK ENS C�MPENSATION INSURANCE AND RCW 18.27.
OFF7AL
SIGNED
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RELEASE
ATTEWION
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 CERTIFk
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109
FAX
10101
FEE
Recording Fee
City Surcharge
State Surcharge
Plan Chk Deposit
Receipt #
Total Amount Due
Receipt #
PPUCATION APPROVAL
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ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER COLD - ASSESSOR
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FINAL PROJECT APPROVAL —FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTNIENT DATE-
P— 2jcl 2—
ENGINEERING DIVISION DA' 10
DIVISION DATE-
PROJEC
SMADDRESS Da4�%�
PERM _____---PATE INSPECTED
�ADB#
O;TO/.RK TO BE INSPECTED
DESCRIPTIONOM
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
PERM E 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
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contractor by inspector
I
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 .................
Retaining Wall ...........
-4
Slab Insulation ..........
pill
PLUMBING:
Underground .............
Rough -In .................
IT
C=
ITI
Final
-10
Commercial
0
HEAT ING:
4
3: m
Fi
Gas Test ............
10
Z
Gas Piping ...............
Equipment
CA
Commercial Final
0 "n
0
NA
-X4 E
EXTERIOR SHEATHING
M M
NAILING .............. ...........
0,_
FRAMING ...............
0 M
C: cl)
FIRST FLOOR FRAMING.;.
IT! 0
INSULATION .............
z
Floor Insulation
Wall Insulation ...........
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Calling Insulation
SHEETROCK NAILING
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SPECIAL INSPECTION
0
IT1
MISCELLANEOUS
FINAL APPROVAL FOR
OCCUPANCY ..................