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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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VALUATION I FEE
PLAN CHECK FEE
HEAT SOURCE GLAZING LOT SLOPE %
BUILDING
PLAN CHECK N IVESTED DATE
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
L BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN JCUMBS, SIDEWALKS, DRIVEWAYS , MARQUEES, ETC.) WILL REQUIRE
GRADTINGIFILL
L SEPARATE PERMISSION.
2
PERMITAPPLICATI N: 100 DAYS
P. PERMIT LIMIT. I YEAR - PROVIDED W RK IS STARTED WITHIN 180 DAYS
END REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
PLICANT. ON BEHALF OF HIS OR HER SPOUSE� HEIRS. ASSIGNS AND SUCCESORS
ENG, INSPECTION FEE
;A
N NTIEREST� AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANYAND
INSPECTION FEE
ALLCOIMS FOR DAMAGES OFWHATEVER NATURE, A131SING DIRECTLY08 INDIRECTLY
FA M THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT $HALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITYORDINANCE
PLAN C HECKDEPOSIT
REG
0 NOR LIMIT IN ANY WAYTHE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.�
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CO RECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CI Y AND STATE LAWS REGULATING G.NSTRUC.
TION; AND'IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
CALL
TP,Pp1.I 11 PIT I P11111 �, I'.
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IN VIOLAT 0 OF THE LABOR CODE OF THE STATE OF WASHINGTON RE LATiNG TO
FOR INSPECTION
WORKMEN'S COMPENSATION INSURANCE AND RCW 1 B.27.
OFFI At SIGNAT E
DATE SIGNED
(425)
771-0220
DATE I
ATTENTION
EXT 333
IT IS UNLAWFULTO USE OR OCCUPY ABUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL -FILE - YELLOW -INSPECT&
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK . OWNER - GOLD � ASSESSOR
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FINAL PROJECT APPROVAL FORM
TO: 2- (In -A,
DATE.q440Z_
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: ----FIRE DEPARTMENT DATE
ENGINEERING DIVISION DATE
PLANNING DIVISION DATE
PROJ EC
SrI'E ADDRESS
PERmrr#PaO _Uao aDB#. _ZDATE 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 BONDS and the granting of:
____�GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS 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 Si
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
wall ..............
Pier/Porch .................
Retaining Wall ...........
Slab Insulation
PLUMBING:
Underground .............
Rough-In ................
Commercial Final
HEATING:
GasTest ....................
Gas Piping ..� ..............
Equipment ., ..............
Commercial Final
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ...................
FIRST FLOOR FRAMING
INSULATION .............
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ........ ... 4,
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