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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
NAMEINAME OF BUSINESS
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FLAT NAMEISUBDIVISION NO.
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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YES 13 NO 13
REMARKS
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PERMIT COVERS wony(TO
Mechanical
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t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
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DOMAIN JCURSS, SIDEWALKS, DRIVEWAYS MARQUEES, ETC.) WILL REQUIRE
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SEPARATEPERMiSSION.
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PER rrAPPUCATION: INDAYS
City Surcharge
PERMIT UNIT I YEAR - PROVID _D WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
State Surcharge
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT ON BEHALF 01 'I'S OR HER SPOUSE, HEIRS. ASIIINI AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS
Traffic Mitigation
Plan Chk Deposit
THE CITY OF
a EDMONDS, WASHINGTON. ITS OFFICALS. EMPLOYEES, AND AGENTS FROM ANY AND
Fire Review
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER, NATURE ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF MIS PERMIT. SISUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY C Ty ORDINANCE
Fire Inspection
Total Am
o N OR LIMIT IN ANY WAY THE CIW6 ABILITY TO ENFORCE ANY ORDINANCE PROVISION.
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Landscapoinsp.
Receipt #
BY
I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION
—
APPROVAL
GIVEN IS CORRECP. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNEK I AGREE TO COMPLY WITH CITY AND STAT LAWS REGULATING CONSTRUC'
CALL
This OPPIJ�atan is ned a Ferran Intil signed by In
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
BuIlding OnAd.1 .1 hulher Deputy: and Fees are paid
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WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. N
DATE
SIGNATURE 07 G,
(425)
IL
771-0220
RELEASED BY DATE
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ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
EXT 1333
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIG NACF�E\- YELLOW. INSPE60
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109
FAX
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FINAL PROJECT APPROVAL -FORM
TO:
DATE'
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM- �IRE DEPARTMENT DATE —
ENGINEERING DIVISION DATE —
PLANNING DIVISION DATE_%I 6 �0
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A fleld inspection was conducted to determine final, compliance with approved plans. Final -approval
from the above signed Department to the release of
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denotes that there are no objections
I_gMANCE BONDS and the granting of:
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GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL wyni CONDITIONS NOTED
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FAILED FINAL INSPECTION OUTSTANDING ISSUES
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RE -INSPECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
Date_— Sign_
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACK$ ...........
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INSULATION ..............
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Coiling Insulation
SHEETROCK NAILING
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