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CITY OF EDMONDS
USE
ZONE _2
PERMIT
NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB
SUITE/APT#
ADDRESS
OWNER NAMEINAME OF BUSINESS
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PLAT NAME/SUSDIVIBION NO.
LOT NO,
U NO*
LID FEE $
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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METER SIZE IINESI
PRV REQUIRED
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OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
FIRE REVIEWED By
CITY 11P TELEIHONI
VARIANCE OR C�
STATE LICE BE NUMBER EX !RA ION DATE CKED BY
P FCKE —
SERA REVIEW
PROPERTYTAX ACCOUNT, COMPLETE . EXE
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FENCE
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REMARKS VE
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ROCKERY
RENEWAL
(ME OF USE. BUSINESS OR IVITY) EXPLAIN:
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PLAN CHE22:
VISTEO DATE
Plumbing
Mechanical
THIS PERMIT AUT OFUZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
Go"N (CURBS, SIDEWALKS, DRIVEWAYS MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERM;SSION. —
Engr. Review
PE MHTAPPUCXINON: 180DAYS
PERRAT LIMIT" I YEAR -PROVIDED WORK ISSTA DWITHININDAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-APPLIC T, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUC ESORS
Traffic Mitigation
1. VITENEEST, AGREES TO INDEMMIFY, DEFEND AND HOLD HARMLESS THE C
CRYO'
"MON", WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM - AND
Fire Review
ALL CLAIMS FOR DAMAGES OFWHATEVE NATURE, ARISING DIRECTLY OR INDIREO
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY EOUIREMENT OF ANY CITY ORDINANCE
Fire Inspection
CRIYS ABILITY TO ENFORCE AN
NOR LIMIT IN ANY WAY THE Y ORDINANCE PROVISION,'
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I HEREBY ACKNOWLEDGE THAT I HAVE RE THIS APPLICATION: THAT THE INFORMATION
GIVEN IS COARECT,. AND THAT AM THE OWNER, OR THE Duty AUTHORIZED AGENT OF
THE OWNEFL I AGREE To COMP WITH C17Y AND STATE LAWS REGULATING CONSTRUC.
TION: AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
CALL
IN VIOLATION OF THE LABOR CODE OF THE STAT OF WASHINGTON RELATING TO
FOR INSPECTII
WORKMEN'S COMPENSAT!2KN URYUNCE AND RCW 18.27.
SJGNATUR�,MWNEA OR kGENT) DATE SIGNED
(425)
771-0220
EXT 1333
IT IS UNLAWFUL TO USE =Npy BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION I Is M _�_ AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109
10/01
FAX
DATE
ALLOWED I PROPOSED ALL PRO
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REQUIRED SETBACKS (FT.) PROPOSED SETBACKS IFL)
F �NT SIDE R.G
RONT SIDE fl� FRONT Lin SIDE BEAR
LOT Al 1 7 TEn
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IN NT
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FEE I Description I FEE
Recording Fee
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State Surcharge
Plan Chk Deposit
Receipt
Total Amount Due
APPLICATION APPROVAL
This appueston is not a permit until signed by the
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C-ITY OF EDINIONDS
RUU)ING DEPARTMENT
APPROVED DATE:
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMOTO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE —
ENGINEERING DIVISION DATE—
E —2
PLANNING DIVISION DAT
V- ��M I
PROJECT
Java
SITE ADDRESS
9-7
PERMIT #__Z Co)?- [05 9 B# 6 1 DATE INSPECTED—
SL
DESCRIPTION OF WORK TO BE INSPECTED
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:
—,X—GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WrIH CONDITIONS NOTED
c, Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
C3 Copy of CORRECTION NOTICE given to owner/contractorby inspector
1.
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
V
Pier/Porch .................
Retaining Wall ...........
Slab Insulation
PLUMBING:
Underground .............
C
M C3
Rough -In ............
0
Commercial Final
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HEATIN
10-4
Gas Tek ..........
q 1
Gas Piping
Equipment .................
Commercial Final
ITI 171
EXTERIOR SHEATHING
0
NAILING .......................
FRAMING ..................
17110�
FIRST FLOOR FRAMING
;13
INSULATION ...................
Floor Insulation
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Wall Insulation ...........
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Coiling Insulation
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SHEETROCK NAILING
0
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SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
07
OCCUPANCY ..............