20020269.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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THIS PERMIT ALITHORUMS ONLYTHE WORK NOTED. THISPE_
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PE MITAPPLICATION: IWDAYS
!PROVIDED
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City Surcharge
PERMIT UMM. I YEAR WORK 15 STARTED WITHIN 180 DAYS
Engr. Inspection
State Surcharge
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF IS OR HER SPOUSE. HEIRS. ABSK3141 G SUCCEE.Ra
Traffic Mitigation
Plan Chk Deposit
IN INTER ST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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EDMONDr; WASHINGTON, ITS OFFICIALS, EMPLOYEES. Also AGENTS FROM ANY AND
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CLAJMS FOR DAMAGES OF WHATEVER
Fire Review
Receipt #
ALI. NATURE, ARISING DIRECTLY OR INDIRECTLY
V901A THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT $HALL NOT BE
DEEMED To MODIFY. WAIVE OR REDUCE ANY EQUIREMENT OF ANY CITY ORDINANCE
Fire Inspection
Total Amount Due
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NOR LIMIT IN ANY WAY THE DRYS ABILITY TORENFORCE ANY ORDINANCE PROVISION.-
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I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN is CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPR
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC�
CALLC
I his 8PPIle'llon Is not a Permit until Nosed by the
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
WORKMENS COMPENSATION INSURANCE AND now 18.97.
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FOR INSPE TI IN
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SIGNATURE (OWNER tfE�l
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DATE
A TTENTION
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IT IS UNLAWFUL To USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPA�l HAS BEEN GRANTED UBC ;T13 10
FAX
ORIGINAL . FILE YELLOW - INSPECrIOR
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FINAL PROM T APPROVAL -FORM
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A Held inspecdo n was conducted to determine final compliance with approved plans. Final approval
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denotes that there are no objections from the above signed Dep artment to the release of
PERFORMANCE BONDS and the granting of
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GRANT FINAL PROJECT APPROVAL
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
a Copy of CORRECTION NOTICE given to owner/contractor by inspector
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REMNSPECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
Date— Sign,
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACK$ .....................
FOUNDATION:
Footing ...........
wall ............
Pier/Porch
Retaining Wall ..........
Slab Insulation
PLUMBING:
Underground . ............
Rough -In ...................
Commercial Final
HEATING.
Gas Test ....................
Gas Piping ..........
Equipment
Commercial Final
EXTERIOR SHEATHING
NAILING ..........................
FRAMING
FIRST FLOOR FRAMING...
INSULATION ....................
Floor Insulation
Wall Insulation ...........
Ceiling Insula tion
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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