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CONSTRUCTION PERMIT APPLICATION 'A'QG
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NAME
FLAT NAMFISUBDIVISION NO. LOT 110, LID NO,
MAILI G ADD ESS I US FEE I
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NAME METER SIZE LINE SIZE NO* 01 FIXTURES REQUIRED
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ADDRESS REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIORAINAGE
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STATE LICENSE NUMBER EXPIRATION REOID POSTED
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PROPERTY TAX ACCOUNT;0EL NO. C MPLETT EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
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NEW RESIDENTIAL PLUMBING / MECH LOT COVERAGE REQUIRED SMACKS (Fo PROPOSED SETSACK$ "'T
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ADDITION COMMERCIAL COMPLIANCEOR
13 CHANGEOFUSE
______T -LOT AREA
- - - PARKING PLANNING REVIEWED BY DATE
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REMODEL MULTIFAMILY SIGN REOD PROVIDED
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PROGRESS INSPECTIONS PER USC 108/FINAL INSPECTION REaD
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Description FEE Description FEE
Plan Check State Surcharge
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PLAN CHECK NO: ;TED DATE Plumbing ITI
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THIS P RMIT AUTHORIZES ONLY THE WO K NOTEM THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
M DOMAUN (CURBS, SIDEWAU�S, DFHVEWAYS MARQUEES, M.) WILL REQUIRE
SEPARATE PERU; SSION. Engr. Review
PER IT APPLICATION: IN DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPILI ANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
IN INTCREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, IMPLOY111, AND AGENTS Flo" ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE I SUANCE OF THIS PERMIT ISSUANCE F THIS PERMIT SHALL NOT BE Landscapelnsp. Total Amt. Due
DEEMED TO MOO]= OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY CtTYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Recording Fee Fec-v�, 122�
I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT T14E INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I A THE OWNEk OR THE DULY AUTHORIZE AGENT OF
I he.PpL'..fl.n'j's,naA a pearni-IM signed by in
THE OWNS . I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONMUC� CALL
Sell
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED goffi-I., h be, Deputy: and Fees arc paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION -alpt 1, ack-tedged in space provided.
W0aKMgJTS CO.IENS=ANCE AND ROW 10.27. OFFICIALS
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DATE 11�10
(OWNIR 01 (425)
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IGNATUIE
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As RE[ EASED BY SATO
ATTENTION M 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL I
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109 PINK�OWNER GO -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
FINAL RROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: _____YIRE DEPARTMENT DATE
ENGINEERING DIVISION DATE -
PLANNING DIVISION DATE-
PROJECT,?!�a-","/
S]TEADDRESS !g��L
PERMIT #_2eo 2 -o-jg ADB#_________pATE INSPECT
pATEINSPECT
INSPECT
DE SCRIPTION 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 o f
PERFORMANCE BQNDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL wrrH coNDrrioNs NOTED
u Copy of CONDITIONS given to owner/contractor by inspector
1
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contractor by inspector
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 ................
Pier/Porch .................
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Retaining Wall ...........
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Slab Insulation
PLUMBING:
Underground .............
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C:
Rough -in ...................
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0
Carnmerdial Final
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HEATING:
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Gas Test ....................
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Gas Piping
Equipment .................
Commercial Final
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EXTERIOR SHEATHING
NAILING ..........................
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0
FRAMING ........................
0
FIRST FLOOR FRAMING
INSULATION . ............
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Floor Insulation
Wall Insulation
Ceiling Insulation
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SHEETROCK NAILING
SPECIAL INSPECTION
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MISCELLANEOUS
FINAL APPROVAL FOR
OCCUPANCY ...............