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PERMIT EXPIRES
CITY OF EDMONDS
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CONSTRUCTION PERMIT APPLICATION
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OWNER NAMEINAME OF BUSINESS
PLAT NAMEISUBDIVI SION NO
LOT NO,
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REMARKS
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CHANGE OF USE
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• REPAIR C3 GRADING CYCS 0 F NICE
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REMARKS
PROGRESS INSPECTIONS PER USC 108TINAL INSPECTION REQ'I
VALUATION I FEE
PLAN CHECK FEE
HEAT SOURCE GLAZING % LOT SLOPE %
BUILDING
PLAN CHECK NO: 111STED DATE
PLUMBING
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MECHANICAL
THIS PERMIT AUTHO MES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. A Y CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
GPADING,PILL
SEPARATE PERMISSION.
-STKrE SURCHARGE
PERMIT APPLICATI N; 180 DAYS
PERMIT LIMIT, I YEAR � PROVIDED WORK IS STARTED WITHIN 180 DAYS
END REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
�AP PLICANT ON SEi ALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
END. INSPECTION FEE
N NTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS HE CITY OF
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LANDSCAP NG
EDMONDS. WA HINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
INSPECTION FEE
ALL CLAIMS FOR DAMAGESOF WHATEVER NATURE, ARISING DIRECTLY OR IN018ECTLY
RECEIPT
FROM THE ISSUANCE OF T IS PERMIT. ISSUANCE OF THIS PERMIT SHALL HOT F
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY OFF ORDINANCE
PLAN CHECK DEPOSIT
NOR LIMIT IN ANYWAY THE CITY S ABILITY TO ENFORCE ANY ORDINANCE PROVISION,�
CEIPT
TOTAL AMOUNT DUE
IR
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IFIERE Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE tN;OP.MAl ION
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WIT?i CITY AND STATE LAWS REGULATING CONSTRUC
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
CALL
TR� Rp,... P., A P-A P, 11.
8."d,, Oth-I , h,sft, Olplly: 1�d 111. P. P. 4-
IN VIOLATION OF THE L ' 'F THE STATE 0 WASHINGTON RELATING TO
Dl,�NCE
FOR INSPECTION ilklmIld9Qqlplll PIP11,I.d.
WORKMEN'S COMPENSAT;FIN21 AND CW 1. �l
(425)
OFFICiAl. �TE
771-0220
llLEAllD 11 DATE
ATTENTION
7OCCUP7I
EXT 1333
1 1 11 - -;E III DING OR STRUCTURE UNTIL
771-0221
1
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL PILE - YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED, USC SECTION 109
FAX
PINK - OWNER - GOLD - ASSESSOR
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE_2�L�--Q
ENGINEERING DIVISION DATE�—
PLANNING DIVISION DATE —
PROJECT
srrEADDREss 1610 6aa—,,ov(6f,
PERMIT #9-06?-- 6 qq ADB#--------PATE INSPECTED
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 BQNDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROTECT APPROVAL WIT11 CONDITIONS NOTED
a 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-ImspECTED 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 ..........
0
M;
PLUMBING:
Underground .............
Rough -in
ITI
C:
............
1711
0
Commercial Final
0 0
HEATING:
M
Gas Test .............
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Gas Piping ..............
Equipment ...............
Commercial Final
0 "n
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EXTERIOR SHEATHING
11111 IT!
NAILING ..........................
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0
0
FRAMING ........................
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FIRST FLOOR FRAMING
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INSULATION ...................
Floor Insulation
Wall Insulation ...........
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Ceiling Insulation
SHEETROCK NAILING
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SPECIAL INSPECTION
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ...............
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