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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PERMIT EXPIRES
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PERMIT
NUMBER
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PLAT NAMEISUBDIVISION
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LID FEE $
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EXISTING
— PROPOSED
REOLOREDDEDiCAlION— FT
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NAME METER SIZE
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NO OF FIXTURES
11111FEI
YES
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ADDRESS REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY
NAMEtoi�rt ENGINEERING REVIEWEDIDATE
ADDRESS
FIRE REVIEWED By DATE
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VARIANCE 01 CU OR AOSO WSP BOND
STATE LICENSE NUMBER 1XIIIIATION DATE CHECKED BY 4 iCTION
C3 Y RE POSTED
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SERA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL.N COMPLETE EXEMP �AL7LOW , PROPOSED )LIWID , P OPOSED
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LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT)
0 PLUMBING I MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
COMPLIANCE OR
E] ADDITION C ANGI OF USE
PARKING DATE
E3 REMODEL SIGN RE
[3 REPAIR GRADING CYUE PENCE
I X IT) -kE.AFKS
DEMOLISH TANK OTHER
oGARAGE RETAtNINGWALL RENEWAL
CARP013T U-` ROCKC Y
(TYPE OF USE. BUSINESS OR ACTI��PLAIN;
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CRITICAL
11CIALIHECTOR JAPE1 OCACCUPANT
IN fELLINO AREAS TP
MIER I MIA
ITS UMBER R E.URE. S Lo
DESCRIBE WORK TO BE DONE t
REMARKS
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REO'D
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PLAN CHECK NO:
IVESTE D DATE PLUMBING
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MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK To
BE DONE ON PRIVATE P OPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADPIGIFILL
DOMAIN (CURDS, SIDEWALKS, DRIVE , MARQUEES, ETC.) WILL REQUIRE
SEPARATEWEAYSMISSION,
PEFIMITAPPLIVATI N: ISO DAYS
PERMIT LIMIT. 1 YEAR -PROVIDED WORK IS STARTED WITHIN ISODAYS
EN.. NEYI.W�E:ES
S66 SACK OF PINK PERMIT FOR MORE INFORMATION
ENG. INSPEc RON FEE
;A PLICANT, ON BeHAL OF HIS OR HER SPOUSE, HEJRS� ASSIGNS AND SUCCES02S
N"INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGEN S FROM ANY AND
ClUAIMSFOR DAMAGESOF WHATEVER NATURE, ARISING DMEC_
PH M THE I SUANCE OF THIS PERMIT, ISSU CE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
0 MED TO MODIFY, WAIVE OR REDUCE ANY REOUIREMENTOF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAYTHE CITYS ABILITY TO ENFORCE ANY ORDINANCE PR.Y-0-
RECEIPT
R'CE'
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, TOIAL A I DUE
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I HEREBY 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
CONSTRUG.
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T
T EOWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING
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NO PERSON WILL BE E
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Bn,ldllg Olh.al , InWhor Gdd.t, and Fad,- p,,d. and
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TiONT AND IN DOING THE WORK AUTHORIZED THEREBY,
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N VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON HE ATING TO
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IOR IN P ECTION
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WORKMEWSCOMPENSAT�q��RANCE NORCINIS27.
OFF DATE
OPWALSSIGNATURE
ATIi SKIN1.
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/ �,���,WNER.
771 -0220
DAY E
ATTENTION
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IT IS UNLAWFUL TO USE 08 OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL ClOR
CATE OF OCCUPANCY HAS BEEN GRANTED� UBC SECTION 109
FAX
PINK - OWNER COLD - ASSESSOR
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FINAL PROJECT APPROVAL FORM
'BUILDING TO: .
APR 2 9 2002 DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE�__
ENGINEERING DIVISION DATE
PLANNING DIVISION DATE 0 1-
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PERMIT#_203�1 �ADB#_DATE INSPECTED Z11(
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 RONDS and the granting of:
-GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WrM CONDITIONS NOTED
a Copy of CONDITIONS given to owner/contractor by inspector
,rED FINAL INSPECTION - OUTSTANDING ISSUES
Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3
RE_iNspE,cTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date�__ Si
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FINAL PROJECT APPROVAL FORM
TO:
DATE�
MEMOTO: PERmrr COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE —
ENGINEERING DIVISION DATE —
"An PLANNING DIVISION DATE
PROJECT—
SITEADDRESS
PERmrr
____L�ATE 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
PERFO_RMANCE BONDS and the granting of:
/K- GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITII CONDITIONS NOTED
ri Copy of CONDITIONS given to owner/contractor by inspector
I
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contractor by inspector
1
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date— Si
ocapxv1.doc.1:temp:b1dg:fonw 10/01
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing. ................
wait .................
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Pier/Porch .................
Retainlrig Wall ...........
Slab Insulation
PLUMBING:
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Underground .............
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Rough -In .................
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Commercial Final
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HEATING:
10-4
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Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final
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EXTERIOR SHEATHING
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NAILING ..........................
FRAMING � .......................
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FIR ST FLOOR FRAMING_
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INSULATION ...................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
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SHEETROCK NAILING
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SPECIAL INSPECTION
MISCELLANEOUS
FINAL APPROVAL FOR
OCCUPANCY
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