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PERMIT EXPIRES
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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THISPERMITAUT ORIZESONLYTHEWORKNOT THIS PERMIT COVERS WORK TO
'C.O'NSTRUCTION
11 GORE 11" PRI PROPERTY *"I I ON THE PUBLIC
Grading
Recording Fee
QoBUUN JCURSS, SIDEWALKS, DRIVEWAYS, MARQuE0, ETC.) WILL REQUIRE
SEPAEUITEPERMISSION.
Engr. Review
City Surcharge
PERMRIAPPLICATI N: IWDAYS
PERMETLEEIRE 1 YEAR- PROVED D WORK IS STARTED WITHIN INDAYS
Engr.inspection
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; 13ACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BSHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Traffic Mitigation
Plan Chk Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARM ESS THE CITY OF
Receipt #
EDMONDS, WAIIIINGTON, 118 OFFICIALI, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE ARISING DIRECTLY OR INDIRECTLY
Fire Review
FROM THE ISSUANCE OF THIS PERMIT. SSUANCi OF THIS PERMIT $HALL NOT BE
DEEMED To MODIFY WAIVE OR BE UCE ANY REQUIREMENT OF My CITY ORDINA CE
Fire Inspection
Total Amount Due
NOR LIMIT IN ANY VAY THE CHYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
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Receipt #
I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPUCATION: THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT., AND T14AT I AM THE OWNER. OR TH OULY AUTHORIZED AGENT OF
THE OWNE . I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CQNSTRUC�
CALL
Th plicallon Is not a pumil unfif.lp.d by III.
TION. AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERS N WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
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WORKMEN'S COMPENS�NCE AND RCW 18 7.
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IT IS UNLAWFUL To USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER GOLD - ASSESSOR
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MEMO TO: PERMIT COORDINATOlk, BUILDING DIVISION
FROM: DEPARTMENT DATE
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PLANNING DIVISION DATE
PROJECT
SITE ADDRESS
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-DATEINSPECTED
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
RERFORMANCE BONDS and the granting of:
---X-GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WTM CONDITIONS NOTED
a Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
E3 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 ...........
Slab Insulation .......... .
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PLUMBING:
Underground ..........
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Rough -in ...................
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Commercial Final
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HEATING:
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Gas Test ....................
10
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Gas Piping .................
Equipment .................
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Commercial Final
EXTERIOR SHEATHING
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NAILING ..........................
0
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FRAMING ........... ............
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FIRST FLOOR FRAMING
INSULATION ...................
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Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
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SPECIAL INSPECTION
MISCELLANEOUS
FINAL APPROVAL FOR
OCCUPANCY ...............
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