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CITY OF EDMONDS
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CONSTRUCTION PERMIT APPLICATION
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FIRE REVIEWED By DATE
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STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY
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PITY Ax ACCOUNT PARCEL NO.
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COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
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NUMBER NUMBER OF CRITICALLW MM-1;
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REMARKS
PROGRESS INSPECTIONS PER UBC 11081FINAL INSPECTION REaO
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GLAZING% LOT SLOPE %
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THIS PERMIT AMMORIMS ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
BEDONEOM PRIVATE PROPERTY 0 NLY. ANY CONSTRUCTION ON THE PUBUC
O&WN (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
re Ing
Recording Fee
SEPARATE PERMISSION.
PERMITAPPLKLATI N:
Engr. Review
City Surcharge
ISDDAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 1. DAYS
EngnInspection
State Surcharge
SeSSACK OF PINK PEflMff FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AN. SUC EIORS
IN INTEFIEST� AGREES To INDEMNIFY,
Traffic Mitigation
PkmChkDeposit
DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
Fire Review
Receipt #
A- CLAIMS FOR DAMA..S OR'F WHATEVER, NATURE. ARISING DISECTLY RANDRECTLY
OR
FROM THE ISSUANCE OF THIS PERMIT SSUANCE OF THIS PERMIT SH LL NOT E
DEEMED TO MODIFY, WAIVE Oft REDUCE ANY REQUIREMENT OF ANY CITY OROINANS
Fire Inspection
Total Amount Due
o NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE IAOVISIOCE
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Landscapoinsp.,
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT HE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZE AGENT OF
APPLICATION APPROVAL
THE OWNER. I AGRE TO COMPLY WITH CITY AND STATE LAWS a
I EGULAI ING CONSTRUC.
Tio
CALL
It Is apphosiion Is not ulfil lagled by too
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N; AND IN DING W02K AUTHORIZED THEREEPY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE E!ASOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
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WORKMEITS COMPENSATION INSURANCE AND RCW 18 21.
SIGNATURE 16WAER fin SIGN
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OFFK�ALS SIGNATO DATE
PAGE: MLE
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771-0220
ATTENTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
771-0221
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
ORIGINAL - FILE - YELLOW - 14SPECT'OR
10/01
FAX
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FINAL PROJECT APPROVAL FORM
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DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: ME DEPARTNENT DATE —
ENGINEERING DIVISION DATE........1
PLANNING DIVISION DATE —
PROJECT
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____----PATE INSPECTED--LLLL�-L— —�-
DESCRIPTION OF WORK TO BE
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
PER_FORMANCE BONDS and the granting of:
-L-&GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPRo VAL wrrH CONDITIONS NOTED
a Copy of CONDMONS given to owner/contractor by inspector
FAHM FINAL INSPECTION - OUTSTANDING ISSUES
a Copy of COMMON NOTICE given to owner/contractor by inspector
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2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date_ Si
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SPECIAL INSPECTION
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MISCELLANEOUS
FINAL APPROVAL FOR
OCCUPANCY ..................