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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NA11111E 11
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TELEPHO E
(4 2-0 175 q �41,q
CITY jT11E1HON
ZIP
qF11,33 (7-170) 3&�
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EXPIRES
-PERMIT
USEE PERMIT
ZON
NUMBER
A DOREss 7 -7 --3
PLAT NAMEISUBDIVISION No
LO, No
t to NO
PUBLIC RIGHTOF WAY PER OFFICIAL 5OILETMAP
EXISTING — PROPOSED
REQUIRED DEDICATION
METER SIZE
LINE SIZE
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REMARKS
OWNEG/CONTRACTOK RESPOI IIIIAINA01
NAME
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ADDRESS
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ENGINEERING
or,
ZIP TELEPHONE
FIRE'RENTEWFO BY
GAIL
STATE LICENSE NUMBER EXPIRATION
VARIANCE Oil CU
SHOR11 IFIF Oil A001
INSPr
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OSTED
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PROPE PARCEL NO.
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()'70 - 0007
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COMPLETE EXEMPT
SIGN Ant A
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HIFIGHT
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(P MECH
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ALLOWTED 0
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SETBACAS 117
PROPOSED
FRONT BIDE Aral I
rKotir �1,111/6100�fl'EAR
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ADDITION
COMMERCIAL
COMPLIANCE OR
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CHA E OF USE
No
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SECD PROVIDF:l
AIR DATE
REPAIR
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NUMBER
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DESCRIBE WORK TO BE DONE
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REMARKS
PRO.R.
PROGRESS INSPECTIONS PER USC 109/FINAL iNSPEC
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LOT 31011 1
Building
PLAN CHECK NO: VESTED DATE
in I
Plumbing
THIS PERMIT AUTHOMMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
'a We
Mechanical
kEn
I
a Be DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMMN
(CURELE. SIDEWA"S' OR) VEWAVS, MARQUEES, ETC.) WILL REQUIRE
SEPARATEPERMISSION.
Recording Fee
City Surcharge
ITAPPUCATION:
"E"M INDAYS
PERMIT LIMIT. I YEAR. PROVIDED WORK 15 STARTED WITHIN 188DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
= or
r
Engr, Inspection
State Surcharge
Z'/
-PLICANT, N BEHALF F His OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Traffic Mitigation
Plan Chk Deposit
IN INTEREST, AGREES T INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMOND LIM
I IHINGTCIN, ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
Fire Review
Receipt #
ALL .- MS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE "So"Nos o' THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
EE.E. 10 Mool"Y'. WAIVE OR BE UCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Fire Inspection
Total Amount Due
0 NOR LIMIT IN ANY WAY THE CITYS GBILITY TO ENFORCE ANY ORDINANCE In VISION -
LandSGapoinsp..
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
131VIN IS CORRECT. AND THAT I All THE OWNEB, 01 THE 11112Y nUTIIOIIIID AGENI OF
APPLICATION APPROVAL
THE OWNE . I AGREE TO COMPLY WITH CITY AND STATE LAWS REGUIATING CONSTRUC
N.AND RIN
CALL
ThL, appli,ation is at a ad bpyu "e
Tic DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL 81 EMPLOYED
in VjoLATI o OF THE "BOB
Fail djnq0ft0.I,ah0.jhrn nin.&I.9.
0 at In. and
)1-P`aY
$N AELASING TO
CODE OF THE STAT OF WASHINGTON
WORKMEN COMPENSATION INSURANCE AND Rcw 18.27,
FOR INSPE TION
C
ad ,a do
P .. dra'i ad
FDATE SIGNED
(425)
'CIA' NAT DATE
RELEASED BY BAT
ATTENTION vv
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
FAX
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OWNER/CONTRACTOR IS RESPONSIBLE
FOR EROSION CONTROL AND DAMAGE
W o 04
51TE PLAt4 �llz go' //4-11 I-Ac;,(ZTV4
ADD GUTTERS/DOWNSPOUTS
AND SPLASHBLOCKS
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APPRM
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FINAL PROJECT APPROVAL FORM
TO: -
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE-
-ENGINEERING DIVISION DATE
PLANNING DIVISION DATE-
MOJEC
SITE ADDRESS
PERMIT #-U61- 011 ff --------- -DATE INSPECTED-A-01LI16-7-
DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to detern-due 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
a Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
a Copy of CORRECTION NOTICE given to owner/contractor by inspector
I
2.
3.
R I E-INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date_ Sign_
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INSPECTOR
DATE APPROVED
SETBACKS ..........
FOUNDATION:
od_
Footing ......................
wall ............
Pier/Porch
Retaining Wall ..........
R1
Slab Insulation ..........
PLUMBING:
M
C:
Underground .............
2
At 0�
0
Rough -in ...................
. . ......
Commercial Final
M
M
HEATING:
Gas Test ..........
Gas Piping .................
(j)
0 -n
n
Equipment .................
ITI
Commercial Final
rn
EXTERIOR SHEATHING
0 Fn
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NAILING .......... . .............
90)
Q 0
FRAMING
FIRST FLOOR FRAMING
INSULATION ..................
Floor Insulation
z
Wall Insulation ...........
Ceiling Insulation
NAILING
z
0
SHEETROCK
. ......
R11
SPECIAL INSPECTION
MISCELLANEOUS
FINAL APPROVAL FOR
vv
OCCUPANCY .............
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