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PERMIT EXPIR ES
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CITY OF EDMONDS ZOE UR
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CONSTRUCTION PERMIT APPLICATION JOE SUITOAPT-
ADDRESS D-Z (o for, Hwy 17
OWNER NAMEYNAME 0; BUSINESS
FLAT NAME;SUBDiVISION N6- -.71D NO.
MAILING ADDRESS LID FEE
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2a-61? 114& 0 1 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP - Zl-
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CITY GIIE IIIETINO -- PROPOSED 0
&PNOMPS 0 �2-,K-7-xq REQUIRED DEOICATION� FT
NAME METER SIZE
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PRY REQUIRE.
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ADDRESS REMARKS
OWNERIGONTRACTOR RESPONSIBLE FOR EROSION CONTROLofum�v%i-a
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NAME
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VARIANCE OR CID SHORELINE Ft A... INSPECTION
STATE LICENSE NUMBER I �1. I TED
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DESCRIBE WORK TO BE DONE
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REMARKS
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC
DOMAIN tCUR5S, SIDEWALKS, DRIVE , MARQUEES, ETC.) WILL REQUIRE
GRADMGIFILL
SEPARATEWAYS
PERMISSION.
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PE MIT APPLMATI.N; 1800AYS
PERMIT LIMIT-. I YEAR - PROVID D WORK IS STARTED WITHIN 180DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'A PLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESDRE
ENG, INSPECTION FEE
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IN INTER ST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
2 EDMONDS. ASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENT S'Ro- ANYAND
INSPECTION FEE
ME FOR DAMAGESOFWHATEVTR NATURE.
q ALL CI.Al ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
RECEIP
OR REDUCEANY REQUIREMIEN
DEE.EDTOMDDIFY.WAIV TOFA YCITYORDINANCE
IN ANY WAY THE
0 NOR LIMIT CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION'
TOTAL AIVOUNT DUE
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I HEFEI ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THAT THE 11 R TION
GIVEN IS CORRECT. AND THAT I AM THE OWNER, 08 THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGUI-ATINGICONSTRU"'
CALL
TJ,H,,ppI—P.— —1. PP-11 U01 �11- b, Il.
7iON, AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
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WORKMEN'S COMPENSAT?N%kSUR NCE AND RCW 18 17
OFF tA SIGNAT E
SIGNATURE='
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(425)
—111
771-0220
GATE
ATT N
EXT 1333
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-
CATE OF OCCUPANCY HAS BEEN GRANTED, UBO,-ECTION 109
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FINAL ROJECT APPROVAL FORM
TO. -
DATE:
I�IEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE -
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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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GRANT PROJECT APPROVAL WYIH CONDITIONS NOTED
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
Copy of C4XWEC9ff0N-N0Tl CE given to owner/contructor by inspector
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RE -INSPECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
Date-Sign_
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
3
SETBACKS .....................
FOUNDATION:
Footing ........... ..........
wait ...................
Pier/Porch ............
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Retaining Wall ...........
Slab Insutatjon
PLUMBING:
0
Underground
C a
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Rough -in ..........
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Commercial Final
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HEATING:
171
10
GasTest ..................
Gas Piping ..........
Equipment
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Commercial Final
MT
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0
EXTERIOR SHEATHING
NAILING ..........................
0
FRAMING ........................
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FIRST FLOOR FRAMING
INSULATION ....................
Floor Insulation
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Wall Insulation ...........
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Ceiling Insulation
SHEETROCK NAILING
0
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SPECIAL INSPECTION
MISCELLANEOUS
FINAL APPROVAL FOR
OCCUPANCY ..................