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PERMIT EXPIRES
CITY OF EDMONDS
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CONSTRUCTION PERMIT APPLICATION
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FLAT NAMEISUBDIVISION NO.
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REMARKS
OWNERICONIRACTOR RESPONSIBLE FOR EROSION CON TROLIORAINAGE
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VESTED DATE
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THIS PERMIT AUTHORIZES ONLYTHE ORK NOTED. THIS
PERMITCOVE" 77.RKT.
Mechanical
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BE DONE ON PRIVATE PROPERTY ONLY. AM CONSTRUCTION ON THE PUBLIC
0 OMAMN
Grading
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(CURBS, SIDEWALKS, DRIVEWAYS
SEPARATE PERM; MARQUEES, ETC.) WILL REQUIRE
SSION.
Engr. Review
PE Min APPLICATION: IN DAYS
PERMIT LIMITT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
See BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLIC NT, ON BEHALF OF HIS OR HER SPOUS � HEIRS, ASSIGNS AND SUCCESORS
Fire Review
PlanChk.Deposft
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IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARM ESS THE CITY OF
EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANYAND
ALL CLAIMS FOR DAMAGES OF WHATEVER
Fire Inspection
Receipt N
NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapeinsp,
Total Arnt. Due
NOR LIMIT IN ANY WAY THE CITY$ ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
!ecodmg Fee
Receipt #
" RE"
HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICARON; THAT THE INFORMATION
G'V N
GIVE" IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
40111
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THE OWNE . I AGREE TO COMPLY WITH CITY AND STATE LAWS R5GULATI -
NG CONSTRUC
CALL
This appliontion Is not a penni—fli sighod by th.
LTII'E
I'D.
I TION, AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLAT N OF THE 09 OF THE STATE OF WASHING IN RELATING TO
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W.FRGVL OR W I To
WORKMENIOCOMPENSA7T_..N -.C.ANE)FICINULZI.
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SIG HE IOWNE R BE
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D E SIGNED
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$L.ABE
771-0220
B., DOE
ATTENTION
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
*'N6F.T.L
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
ORIGINAL FIL
PINK OWNER - G LD-ASSESSOR
N/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
FINAL PROJECT A ALFORM
DATE: 1,1q
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTYMNT DATE —
ENGINEERING DIVISION DATE—
ZLANNING DIVISION DATE_1�
PROJECT
SITEADDRESS
pEMT#L�����ADB#�42-40� D—ATEINSPECTED
DESCRIPTION OF WORK TO BE INSPECT
67
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
PERF LvL_4LNCEBONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
a Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES ctor by inspector
a Copy of CORRECTION NMICE given to owner/contra
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date— Sign—
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
wall ...........
Z,
Pier/Porch .................
Retaining Wall ...........
Stab Insulation ..........
PLUMBING:
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Underground .............
M 0
0
0
Rough -in ...........
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Commercial Final
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HEATING:
C
Ga s Test .............
Gas Piping ...........
0
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Equipment ...............
Commercial Final
RIM
a
EXTERIOR SHEATHING
0
0 Fn
NAILING ..........
C (A
Q 0
FRAMING ........................
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FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
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Wall Insulation
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Ceiling Insulation
0
SHEETROCK NAILING
0
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SPECIAL INSPECTION
MISCELLANEOUS
FINAL APPROVAL FOR
OCCUPANCY ..............