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1 PERMIT EXPIRES
CITY OF EDMONDS
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PERMIT
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NUMBER CC 3
CONSTRUCTION PERMIT APPLICATION
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NAME Is IZE NO, OF FIXTURES PRV REQUIRED
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ADDRESS REMARKS
NERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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IRO EATY TAX ACCOUNT PARCEL NO,
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(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
CHECIEOSY OCCUPANT
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NUMBER NUMBER OF
OF DWELLING
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GRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REGIV.
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VALUATION $
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Description
FEE__ Description FEE
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Plan Check
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"e-Building
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Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORKTO
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BE DONE ON PRIVATE PROPERTY ON- ANY CONSTR CTIONONTHEPUBUC
Grading
Recording Fee
r RIVEWAYS, MARQUE
DOMAIN (CUASS,SIDEWALKS,0 ES,ETC.) WILL REQUIRE
3 SEPARATE PERMISSION.
Engr. Review
City Surcharge 12-
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PERMITUM .1YEAR-PROVIOSIDWORKI..RTEDWIT-111 ISOOAYS
Engr. Inspection
State Surcharge Z
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SEE BACK OF PINK PEFIMM FOR MORE INFORMATION
Plan Chk Deposit
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-APPLIC ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
Traffic Mitigation
R E CITY
IN —A`rr'T. A..... TO INDEMNIFY, DEFEND AND HOLD HARMLESS TH CITY OF
Rec elpt #
JEDMONDE WASHINGTON ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIM FOR DAMAGE� OF WRATEVER NATURE, ARISING a OR INDIRECTLY
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TERCMIT
Fire Review
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THI Sp SHALL NOT BE
Fire Inspection
Total AMOUnt Due
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DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 ON
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVIS! N.
IGENT
Receipt #
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMA 10
APPLICATION AP PROVAL
GIVEN is CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED OF
THE OWNS . I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
This application Is, not a Pon," u
.P-Y�D
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
'T' . To
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
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FOR INSPECTION
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WORKMENS Q 911VIPMOATION-11 SURANCE AND RCW 10.27,
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0 LS SIGNATURE DATE
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77(1425)
-0220
ATTENTION
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 �, CERTIFI-
ORIGINAL�FIIE YELLOW - 14SPE&OR
CATE OF OCCUPANCY HAS BEEN GRANTED. LED SECTION %J
FAX
PINK -CphNEA GOLD - ASSESSOR
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FINAL PROJECT-A-PPROYAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE-
02—T —ENGINEERING DIVISION DAT]14Lq(�2—
PLANNING DIVISION DATE—
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PROJEC
SITEADDRESS-
PERMIT # .. DATE INSPEC
DESCRIPTION OF WORK TO BE INSPECTED_
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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
PERFORMANCE BONDS 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
u Copy of CORRE CTION NOTICE -given to owner/contractor by inspector
2.
3.
RE-INSpECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date— Sign_
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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
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