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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTRQIJDRAINAGE
FIRE REVIEWED BY
CHECKED BY I
SPECIAL INSPECTOF
REQUIRED [:] YES
LALUATION $
Description
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Description
FEE
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THIS PERMIT AUTHORIZES ONLY THE IN RK NOTED. THIS PERMIT COVERS WORK TO
Mechanical
t: HE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
Recording Fee
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS MARQUEES, ETC.) V41LL REQUIRE
SEPAMTEPERM;SSION,
Engf. Review
City S.rcharg
—
PER HIAPPILICATION: INDAYS
a
PERMIT LIMIT. I YEAR - PROVID D WORK 15 STARTED WITHIN 180DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
-APPLI AN'L ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
Traffic Mitigation
Plan Chk Deposit
67
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IN INTEREST, AGREES To IN.E.N11 DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Review
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANC OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFYWA VE 08 REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Fire Inspection
Total Amount Due
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROViSIOW-
Landscapelnsp.
Receipt #
I HEREBY ACKNOWLEDGE THAT � HAVE READ THIS APPLICATION� THAT 714E INFORMATION
GIVEN IS CORRECT, AND THAT AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION
APPROVAL
THE OWNER. I AGREE To COMP WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
This spirit allon Is net a tendril until signed by the
TION; AND IN DOING THE We K AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
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IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Hull ding Offidl , his/her Deputy; add Foos are paid. and
uneoul—ke-l.do.di-P ... p-Ided,
WORKMEq'S COMPENSATI=URA 18.27.
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DATE1K`7'/'r)
(425)
0 DATE
771-0220
— /I)ATE
BE BED By
ATTENTION
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-
ORIGINAL - FILE YELLdw - INSAECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER - GOLD - ASSESSOR
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATI�--
ERING DIVISION DATE
YLANNING DIVISION DATE
PROJEC
SITE ADDRESS--IZC�a c�2MZ 6 1
PERMIT #42�,= ADB#jOA—=L2P DATE INSPECTEDA/9--�
DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine final compliancewith 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:
X, GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
u Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contractor by inspector
I
2.
3.
RE-INSpECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Datq._ Si
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"FINAL _""t0JECT AP_PROVAL, FOY"'T
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: —FIRE DEPARTMENT DATR_
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PL DIVISION DATE—.
P
SITE ADDRESS SQ), Atka - Sc�
PERMIT# 400a-,04p,+-:�, #__-----PATE INSPECTED 9�1 In
DESCRIPTION OF WORK TO BE INSPECTED_!E�....
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
PERFORNIANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
a Copy of CONDITIONS given to owner/contractor by inspector
1.
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
o Copy of CORRECTION NOTICE given to owner/contractor by inspector
1.
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 ..........
Pier/Porch .................
Retaining Wall ...........
-Stab Insulation
PLUMBING:
Underground .............
Rough4n ...................
Commercial Final
HEATING:
Gas Test .. ..................
Gas Piping ..............
Equipment .................
Commercial Final
EXTERIOR SHEATHING
NAILING ................
FRAMING ........................
FIRST FLOOR FRAMING
-A
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
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.............. .
SPECIAL INSPECTION
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