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I PERMIT EXPIRES
CITY OF EDMONDS
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CONSTRUCTION PERMIT APPLICATION
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ADDRESS
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FLAT NAMEISUDDIVISION NO. :[LOT NO.
110 NM
MAILING ADDRESS
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PUBLIC RIrNT .1 .1 1. OFFICIAL STREET MAP
LID FEE $
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METER SIZE I LINE 1111 1 NO, 01 IIXTURES
PRV REQUIRED
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ADDRESS
REMARKS
WNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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NAME
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FIRE REVIEWED BY
DATE
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STATE LICENSE NUMBER EXPIRATION DATE 21ECKED BY
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$EPA REVIEW SIGN AREA
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PROPERTY TAX ACCOUNT PARCEL NO.
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COMPLETE , E:7 ALLOWED PROPOSED
EXP 1 0
ALLOWED , PROPOSED
1 S- 1 1-415-1
NEW RESIDENTIAL LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SET13ACKS IFT)
0 PLUMBING I MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT LIA SIDE REAR to
ADDITION COMMERCIAL COMPLIANCE OR
CHANGE OF USE
`7 71' .5' 7 57 1
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PA ING LOT AREA PLANNING R
REMODEL APARTMENT SIGN
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FENCE
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REPAIR 0 !�L CYDS 0 ( X M
REMARKS
1:1 DEMOLISH E3 TANK OTHER
j6GARAGE o RETAINING WALL RENEWAL
CARPORT ROOKERY
(ME OF USE, BUSINESS OR ACTSTM EXPLAIN:
CHECKED BY ITYPE Opfr&TjIJfON JC&
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0 OCUPAN
GROUP
NUMBER NUMBER OF CRITICAL
OF DWE NO AREAS4=
STORIES UNITS HUM
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SPECIAL SPECTOR JAREA
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EQUIRE'No YE L
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DESCRIBE WORK TO BE 0 ONE
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REMARKS
PROGRESS INSPECTIONS PER USC 108jFINAL INSPECTION REO'D
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VALUATION $
FEE
Descriptron
FEE
Description_
Plan Check
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HElT$(RCE LaLOPE %
Building
VESTED DATE
PIA.C.:M-
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONILY�RHE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. AM CONSTRUCTION ON THE PUBLIC
Grading
Recording Fee
X0 EES, ETC.) WILL REQUIRE
3 O�N (CURES, SIDEWALKS, DRIVEWAYS MAROU
SEPARATE PERMi SGION.
—
Engr. Review
City Surcharge
6-
le PER TrAPPLICATION: I. DAYS
PERMITLIMR111YEAR-PnOVID DWOFIKIS STARTED WITHIN 160DAYS
State Surcharge
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
'APPLICAK ON BEHALF OF HIS OR HER SIOUSE. HEIRS ASSIGNS AND SUCCISORS
Traffic Mitigation
Plan Chk Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD rintire—o
Receipt #
IV214
X EDMONDS. WASHINGTON, ITS OFFICALS, EMPLOYEES, AND AGENTS FROM ANYAND
A L CLAIMS FOR DAMAGES OFWMTEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
PH M THE ISSUANCE OF THIS PERMIt OF THIS PERMIT SHALL NOT BE
Fire Review
ISSUANCE
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
F to Inspection
Total fiurr,.U:L��el
2 NOR LIMIT IN ANY WAY THE DIM ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Landscapelnsp.
Receipt #
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1 HERE Y 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
THE OWNER. I A.RE To COM111 WIT. CITY It STATE LAWS R�.ULATIN. CGNSTRUC-
CALL
appil'olon Is not a permit until signed
by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATIO OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
S'JITN'
d1url Officnit .1 his/her Deputy; end Fees
FOR INSPECTION nue.1p, Is m,lun—finf,pid torte ...
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WORKMEN'S COMPENSATION INSURANCE AND RCW 18,27,
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On I ;IALS SIGNA
DATE
DATE SIGNED
(425)
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1".1SED-BY
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771-0220
1DATf
ATTENTION
W 1333
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-
RKMNAL � FILE - YELLOW
- IIISPE60R
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER - GOLD - ASSESSOR
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FINAL PRO ECT APPRQVAL FORM
TO:
DATE:
MEMO TO: PERmrr COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE—
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ENGINEERING DIVISION DAT
PLANNING DIVISION DATE —
PROJECT AMf k
SITE ADDRESS lblu,7)
PERMIT #__UC&130_ADB#_______pATEINSPECTEI)
DESCRIPTION OF WORK TO BE INSPECTED
determine final compliance with approved plans. Final approval
A field inspection was conducted to i
denotes that there are no objections from the above signed Department to the release of
pERF_ORMANCE BONDS and the granting of:
--X—GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
u Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
c3 Copy of CORRECTION NOTICE given to oymer/contractor by inspector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date— Sign�
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
wall
T %k
Pier/Porch .................
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0
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Retaining Wall ...........
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M
Slab Insulation
PLUMBING:
-4
Underground .............
0M
Rough -in ...................
ITI
0
Commercial Final
M
HEATING:
IT!
10
Gas Test ....................
Gas Piping .................
Equipment .................
0 1.1
Commercial Final
M M
EXTERIORSHEATHING
vy)s
0
0
NAILING ................
0
C
co
FRAMING ........................
M 0
FIRST FLOOR FRAMING
Z
INSULATION ...............
X
Floor Insulation
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Wall Insulation ...........
x
Ceiling Insulation
z
SHEETROCK NAILING
SPECIAL INSPECTION
0
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MISCELLANEOUS ..........
FINAL APPROVAL FOR �AS
OCCUPANCY ..................
Caw 6-c-42 740