20020482.pdfN DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER UA E1NAM9 OF BUSINESS
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PERMIT EXPIRES
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PLAT NAMEISUBDIVISION NO. L16 NO.
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP 11 Ad—ed
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REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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NUMBER
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DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS
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PER UBC, 108/FINAL INSPECTION REaD
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VALUATION $
Description
FEE
Descripti
FEE
Plan Check
HEAT SOURCE GLAZING Is LOT SLOPE
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PLAN CHECK Nj�
mbing
Plumbing
60
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Mechanic
THIS PERMIT AUTHORUES ONLY THE RK NOTES. THIS PERMIT COVERS WORK TO
c a M Z.0 . .
E DONS ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PU13UC
Grading
Recording Fee
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS. MJUNQUEES, ETC.) WILL REQUIRE
PER I sINON.
PE-FR'c"VI PMUCATOIRKNISISSOTAORATYES
Engr Review
City Surcharge
PERMITLIMIT.11Y WITHIN ' N DAYS
WEE 13ACK OF PINK PERMIT FOR A40RE INFORMATION
Engr. Inspection
State Surcharge
*APPLICANT. ON BEHALF OF 8 OR HER SPOUSE, HEIRS. ASSIGNS -0 SUC ES08S
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Traffic Mitigation
Plan Chk Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AN. ..to HARMLESS THE CITY OF
S EDMONDS, WASHINGTON, ITS OFFICIM.S. EMPLOYEES, AND AGENTS FROM AN� AND
Receipt #
IALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Fire Review
9 FROM THE ISSUANCE OF THIS PERMR. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODHFY, WAIVE OR REDUCE ANY
-ire inspection
r
Total Amount Due
REQUIREMENT OF MY CITY ORDINANCE
21 'OR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Landscapainsp.
Receipt # -
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVE IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNE R1. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUG.
CALL
Ttqs application 1, not a pandi—fil signed by ties
TPON; AND N DOING TH WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
a,
FOR INSPECTION
in Ore that epty: and Foes are Feld, and
WORKMENS COM = S=INSURANCE AND RCW 18,27.
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771-0220 TELL—n
BY
ATTENTION
EXT 1333
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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*INSPECTO
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK -OWNER - GOLD - ASSESSOB
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FINAL PROJECT APPROVAL FORM
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MEMOTO: PERMIT COORDINATCII;� BUILDING DIVISION
FROM: FIRE DEPARTNIENT DATI�-
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PLANNING DIVISION DATE-!�&
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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
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PERFORMANCE BONDS and the granting of:
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KGRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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u Copy ofCONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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a Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign_
ocaprvl.doc.l:tenip:bldg:fonnsIO/OI
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS ..................
FOUNDATION:
Footing......................
wall .............
Pier/Porch ...............
Retaining Wall ...........
Stab Insulation ..........
PLUMBING:
Underground .............
Rough -in ...................
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Commercial Final
HEATING:
GasTest ..................
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Gas Piping .............
Equipment .................
Commercial Final
EXTERIOR SHEATHING
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NAILING .....................
FRAMING
co
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FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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