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CITY OF EDMONDS
us PERMIT
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CONSTRUCTION PERMIT APPLICATION
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PLAT NAMEISUDDIVISION NO.
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LID 110,
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ING ADDRESS
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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PROPERTY TAX ACCOUNT PARCEL NO.
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COMPLETE I EXEMPT
EXP
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ALLOWED , PROPOSED
EIGHT
ALLOWED , PROPOSED
N EW RESIDENTIAL [3 PLUMBING I MECH
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (Fr.)
FRONT SIDE REAR
PROPOSED SETBACKS (Fr.)
FRONT UR SIDE REAR
E3 ADDITION [j COMMERCIAL [3 1 MPUANCE OR
CHANGE Of USE
EMODEL [3 APARTMENT [3 SIGN
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PARKING
REDD I Pecan ED
LOT AREA
PLANNING REVIEWED 11 DATE
GRADING CIDS 0 F NOR
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REMARKS
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DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REOD
VALUATION $
Description
FEE
Description
FEE
-plan Check
HEAT SOURCE GLAZING LOT SLOPE
Building
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PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORMS ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
t: "111111" "1 PROPERTY '"I MY CON11110" IN THE Pull
Grading
Recording Fee
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, UC.) WILL REQUIRE
SEPARATE PERMISSION.
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PER"BrAPPLICATION: 1600AYS
Engr. Review
City Surcharge
PERMIT UARD I YEAR - PROVIDED WORK 15 STARTED WITHIN ISODAYS
Engr. Inspection
State Surcharge
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE , HEIRS, ASSIGNS AND SUCCESORS
Traffic Mitigation
Plan Chk Deposit
IN INTEREST AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON. FIRS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Review
Receipt #
ALL DIMS FO DAMAGES OF WHATEVER MATURE, ARISING DIRECTLY OR INDIRECTLY
F90M THEISSUA CE OF THIS PERMFr. ISSUANCE OF THIS PERMIT $HALL NOT BE
9 DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF MY CITY ORDINANCE
Fire inspection
Total Amount Due
NOR UMrr IN ANY WAY THE CIS ABILITY 1. ENFORCE ANY ORDINANCE PROAS11110
Landscape Insp,
Receipt #
IHERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT JAM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
THE OWNS . I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
T�Issppll.U.a Is net . pee-1-10 signed by 9w
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
y: and Fees am puld. and
sand in spael?p—Ided.
WORKMEWS COMPENSATION INSURANCE AND RCW 10.27,
(425)
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'RATU E
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771-0220
7tKASED BY DATE
ATTENVION
EXT 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-
ORIGINAL - FILE - YELLOW � INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PAY
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FROM:
ENGINEERING DIVISION DATE —
PLANNING DIVISION DATE-
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DESCRIPTION OF WORK TO BE INSPECTED
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A field inspection 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 Department to the rele ase of
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PERFORMANCE BONDS and the granting of:
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GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH 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
SETBACKS ..............
FOUNDATION:
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Pier/Porch .................
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HEATING:
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Gas Piping . ................
Equipment .................
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EXTERIOR SHEATHING
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NAILING .................
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FRAMING ........................
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FIRST FLOOR FRAMING
INSULATION ...................
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Floor Insulation
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Wall Insulation ...........
Ceiling Insulation
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SHEETROCK NAILING
SPECIAL INSPECTION
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................