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[PERMIT
EXPIRES
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
USE PERMIT
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NUMBER
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ebM. WA. C11 6
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PAY REQUIRED
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ADDRESS
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/D"N
'ITY ZIP ITELEPHONE I
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ADDRESS
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FIRE REVIEWED BY DATE
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STATE LICENSE NUMBER EXPIRATION DATE CK Y
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ALLOWED PROPOSED
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LOT COVERAGE
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REQUIRED SETBACKS (FT.)
FRONT SIDE AFAR
PROPO ED SETBACKS (FT.)
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DEMOLISH TANK OTHiR
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LOT AREA
I P��� DATE
REMARKS
oAGE RETAININGWALL FIRE SPRINKLER
CARPORT 171 ROOKERY FIREALARM
(TYPE OF USE. BUSINESS OR A'7176rt!
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NUMBER
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Description
FEE
Description
FEE
Plan Check
('70
State Surcharge
HEAT SOURCE GLAIING I
LOT SLOPE
Building Permit
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City Surcharge
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PLAN CHECK NO: oiq- 410 VEFTED DATE
Plumbing
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THIS PERMIT AUTHORIZE. ONLY THE WORK ..Be. I.I. PERMIT COVERS WORK To
BE DONE ON PRIVATE PROPERTIf ONLY. AM CONSTRUCTION ON THE PUBLIC
Grading
M DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
t: SEPAFATrPERMISSION,
Engr. Revim
Ps MAIAPPUCATIO": INDAYS
PERMrr LIMTP 1 YEAR - PROVIO 0 WORK IS STARTED WITHIN ISODAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
111.11ANT ON 11 UP OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
Fire Review
PlanChk.D.p.ft
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS WASHING ON, ITS OFFICIALS. EMPLOYEES, A 0 AGENTS FROM ANY AND
ALL CLAIMiI FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Fire Inspection
Receipt #
FROM THE I SUANCE OF TH S PERMIT. ISSUANCE OF THIS PERMIT $HALL NOT BE
9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF MY CITY ORDINANCE
Landscape Insp.
nd a
Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
LRecording
x -
Fee
Receipt #
I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVE IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
N
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IC N PPROVAL
47pli
THE OWNE , I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTAUC-
CALL
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TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMP LOT
IN VIOLATION OF THE OF THE STATE OF WASHINGTON RELATING TO
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AT 1.111alrdl.d tay: and Fles am paid, and
FOR INSPECTION a'rI.d ad In IP"'p—Wed.
LI—RKMENS COMPENSA CE AND NOW 18.27,
sirN E (o�I;Es ATE SIGNED
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(425)
OFFI I 'SSGN E JE
C, P 1
1 771-0220
qkASED BY DATE
ENTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
Grit INAL - FILE YELLOW � INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK.O.NEA GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN ACCOUNTING
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FINAL PROJECT APPROVAL FORM
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: -------YIRE DEPARTMENT DATE
ENGINEERING DIVISION DATE
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PLANNING DIVISION DATE
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DESCRIPTION OF WORK TO BE INSPECTED t z6ddQli�l
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A fleld inspection was conducted to determine final compliance with approved plans. Fioaapproval,
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 FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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u Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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a Copy of CORRECTION NOTICE given to owner/contractor by inspector
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RE -INSPECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
Datc�_ Si
ocaprvi.doc.l:temp-bidg:formsIO101
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Stab Insulation
PLUMBING:
3:
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Underground .............
M 0
0
Rough -in ...................
0
Commercial Final
C
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HEATING:
4
Gas Test _ ..................
Gas Piping .................
0,
Equipment .............
Commercial Final
1711 IT!
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EXTERIOR SHEATHING
0
0
NAILING ..........................
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FRAMING ........................
FIRST FLOOR FRAMING
Q 0
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71
INSULATION ...................
Floor Insulation
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Wall Insulation ...........
Coiling Insulation
SHEETROCK NAILING
0
R11
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................