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PERMIT EXPIRES
CITY OF EDMONDS
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CONSTRUCTION PERMIT APPUCATION
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Description
FEE
Description
FEE
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HEAT SOURCE OWING % LOT SLOPE %
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Building
VESTED
PLAN CHECK NO: ESTBD DATE
Plumbing
Mechanical
This PERMIT AUT ORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
0 DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC
Grading
Recording Foe
DOMAIN JCURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.), WILL REQUIRE
12 SEPARATE PERMISSION,
Engr. Review
-5-0 City Surcharge
PE MITAPPLICATION: INDAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS S.ARTEO WITHIN 181IDAYS
Engr. Inspection
State Surcharge
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIR% ASSIGNS AND SUCCESORS
Traffic Mitigation
Plan Chk Deposit
IN INTEREST AGREES TO IND1.1111, DEFEND AND HOLD HARMLESS THE CITY 01
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Fire Review
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FOOM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT S"ALL NOT HE
Fire Inspection
Total Amount Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINA CE
o No R LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION,
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F.-C-107-
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I HEREBY ACKNOWLE GE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVE IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
This application Is not a p-11 until signed by too
TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
I IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
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,NSATION INSURANCE"AND HOW 18.27�
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SIG U (OWNER R AD DATE
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ATTENTION
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IT IS UNI AWFIII TJISE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE J YELLOW -
INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109
FAX
PINK - OWNER - GOLD - ASSESSOR
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FINAL PROVALFORM
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A field inspection was conducted to determine final compliance with approved plans. Final approval
denotes that there are no objections from the above signed Department to the release of
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MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: --FIRE DEPARTMENT DATE —
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DESCRIPTION OF WORK TO BE INSPECTED-h
A field inspection was conducted to determine flual compliance with approved plans. Final approval
denotes that there are no objections from the above signed Department to the release of
pERFQRNLANCE BOND and the granting of:
-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
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
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 Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
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OCCUPANCY ..................
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