20020411.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEN� �Z�;NESS
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NAME
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PERMIT EXPIRES
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PERMIT
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NUMBER
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ADDRESS
PLAT NA.ElSU.CIIISION NO-
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROIJORAINAGE
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NAME
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ADDRESS
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FRONT INDBE REAR
PROPOSED SETBACKS (FT.)
FRONr UPSIDE REAR
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NUMBER OF
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LOAD
DESCRIBE WORK TO BE DONE
REMARKS
P ROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
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VALUATION
FEE
PLAN CHECK FEE
LOT SLOPE %
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PLAN CHECK NO( DATE
PLUMBING
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MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE W RK NOTED. THIS PERMIT COVERS WORK TO
—
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
2 DOMAIN (CURBS, SIDEWALKS, DRIVE S. MAROUEES. ETC.) WILL REOUIRE
m SEPARATEWPEAYRMISSION.
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PERMITAPPLICATI N: IGODAYS
PERMIT LIMIT** I YEAR , PROVIDED WORK IS STAH110 WITHIN III DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENG, INSPECTION FEE
-AP'LtCANl ON BEHALF OF HIS OR HER SPOUSE. HEIR& ASSIGNS AND WICCESORS
IN INTEREST AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Sp
N E 'TK`N
INSPECTION FEE
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
R cE
, �j FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT $HALL NOT 8 EE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REOUIREMENT OF ANY CITY oBDINANG
PLAN CHECK DEPOSIT
FEE
NOR LIMIT IN ANYWAY HE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
T TOTAL AMOUNT DUE
o TAL AMOUNT DUE
I HEREBY ACKNOW EDGE THAT I HAVE READ THIS APPLICATION: THAT THE 114FORMATION
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APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I A. THE OWNER, OR THE DULY AUTHORIZED AGENT OF
T EOWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING C ONSTRUC.
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CALL
T A P.-I �' ��O I,l I'.
TION: AND IN DOING THE WORK AUTHORIZ ED TH EREBY. NO PE FISCH WILL BE EMPLOYED
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IN VIOLATION OF THE ODE OF THE STATE OF WASHINGTON RELATING TO
OR I S P CTIOr
R INSPECTION
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WORKMEN'SCOMPENS �NCEANDRCWIB27.
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SIGNATURE (OWN
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771-0220
1333
YELEASED By
A EVION
EXT
IT IS UNLAWFUL TO USE 08 OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
1
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI.
ORIGINAL FILE YELLOW - INSPECTOR
CATE OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK -OWNER GOLD ASSESSOR
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FINAL PROJECT APPROVAL FORM
DATE:
MEMO TO: PERmrr COORDINATOR, BUILDING DIVISION
FROM: -FIRE DEPARTNIENT DATE -
ENGINEERING 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. ]i nal approval
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denotes that there are no objections from the above signed Department to the release of
p_ERFORMANCE BOND and the granting of:
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FWAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL wrrH CONDITIONS NOTED
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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a Copy of CORRECTION NOTICE given to owner/contractorbY inspector
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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:
Fooling.....................
wait .............
Pier/Porch .................
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Retaining Wall � ..........
Slab Insulation ..........
PLUMBING:
Underground ..........
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Rough -In ...................
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Commercial Final
0
0
.......
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HEATING:
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GasTest ........... ''I
Gas Piping .................
Equipment .................
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Commercial Final
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E)CrERIOR SHEATHING
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 ...........
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Ceiling Insulation
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SHEETROCK NAILING
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SPECIAL INSPECTION
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MISCELLANEOUS ..........