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MIT EXPIRES
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CITY OF EDMONDS
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CONSTRUCTION PERMIT APPLICATION
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PLAT NAMEISUBDIVISION NO. LOT NO, 1111 NO,
MAILING ADDRESS
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP a -
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REQUIRED DEDICATION— FT __ U—m—
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NAME
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NO. .1 FIXTURES
PRV REQUIRED
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ADDRESS
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTAOLJDRAINAGE
CITY TELEPHONE
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NAME
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FIRE REVIEWED BY DATE
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STATE LICENSE NUMBER EX 0 By
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ADDITION COMMERCIAL C MPLIANCE OR
CHANGE OF USE
REMODEL MULTIFAMILY SIGN
REPAIR C] GRADING CyBS F NCE
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DESCRIBE WORK TO BE DONE
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LOT COVERAGE REQUIRED SETBACKS (FT ETBACKS (FT)
LOW SID HEAR I PROPOSED
AL ED PROPOSED FRONT E FRONT LIRSIDE HEAR
PARKING LOT AREA PLANNING REVIEWED BY DATE
REGro PROVIDE
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REMARKS
CHECKED BY TYp F ON
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REMARKS
PROGRESS INSPECTIONS PER I)EIC I../lI.AL INSPECTION REOID
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VALUATION
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Description FEE Description FEE
Plan Check
State Surcharge
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Building Permit
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ON04, ANY CONSTRUCTION ON I HE PUBLIC
OMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
PE MITAPPLOATION: IN DAYS
PEFIMM LIMIT I YEAR - PROVIDED WORK 15 STARTED WITHIN 190 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
50
-APPLICANT. ON BEHALF OF HIS .14 HER SPOLSE. HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNII, DEFEND AND HOLD HARMLESS THE CITY OF
Fire Review Plan Chk. Deposit
EDMOND S. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FO DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY Oil INDIRECTLY
FROM THE ISSUANCE Of THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Fire Inspection Receipt #
Landscapainsp. Total Amt. Due
Recording Fee
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO CO PLY WITH CITY AND STATE LAWS REGO TING CONSTAUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
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IN VIOLA I "N' E OF THE STAT OF WASHINGTON RELATING TO
WORK E COMPE.;�.A ASO BE cE AND FCW 111�W.
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APPLICATION APPROVAL
This Ipplimaka, [irm a permit until Signed by am
CALL and Foos am paid, and
FOR INSPECTION
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SIGN E N E SIGNED
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(425) t, 91/1'Al LIG),
771-0220 DATE
ENTION
LAW
IT IS UN FUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
EXT 1333
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTfFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 ORIGINAL YELLOW - INSPECTOR
PINK OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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FINA PROJECT APPROVAL F&M
FROM: FIRE DEPAMaNT DATE
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ENGINEERING DIVISION DATE—
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PLANNING DIVISION DATE—
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DESCRIPTION OF WORK TO BE INSPEC —8L&zC
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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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Y- GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
o Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
o Copy of CORRECTION NOTICE given to owner/contractor by inspector
MICRO FILM
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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
PLUMBING:
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Underground .............
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Rough -in ...................
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Commercial Final
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HEATING:
Gas Test ....................
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Gas Piping
Equipment .............
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EXTERIOR SHEATHING
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NAILING .............. ...........
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FRAMING ................
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FIRST FLOOR FRAMING_
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INSULATION ..............
Floor Insulation
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Wall Insulation
Ceiling Insulation
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SHEETROCK NAILING
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SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..........