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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ER NAMI21NAME OF SUSINES7
I A C. 1-1 L . '97 - :7 ii?�t\;: el A &JH-4�,
2! 11
CITY zip �� ITEL PHONE _ IZ27 I
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NAME
PERMIT EXPIRES
USE PERMIT
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CC) NUMBER
JOB SUITE/APT#
ADDRESS
2.1 v 7 !2 Iqw��
FLAT NAMEISUBDIVISION NO
LOT NO
LID NO,
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US FEE I
PUBLIC HOW OF WAY PER OFFICIAL STREET MAP
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EXISTING — PROPOSEG�
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REQUIRED DEDICATION— FT
METER SIZE
LINE SIZE
NO, OF FIXTURES
PRV REQUIRED
I
YES E3 No 13.
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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STATE UVE SE NUMBER EXPIRATION POSTED
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SERA REVIEW I.. AREA HEIGHT
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PROTIERTYTAX ACC'6UNT PARCEL NO. "'M 'L-T E.E APT AL ALLOWED PROPO ED
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COMPLIANCE OR t 1 — —
)�A:TION
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0 REPAIR GRADING CYGE fm FENCE
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Ei GARAGE RETAINING WALL E] F RE SPRINKLER
CARPORT ROOKERY FIRE ALARM I A r--r -VJ4--
(TYPE OF USE. SIX 11 EIPLAI�WVt
CHECKED BY ITYPE OFD&O4S�TRTC ION OCCUPANT
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NUMBER ""111111 OF CII TICAL
OF DWELLIN AREAS SPECIAL NSPECIRON OOr
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) [] YE JAREA
STORIES UNITS NUMBER REQUIRE _R LOAD
LuFSORISE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REOD
$ F_
Description FEE
-
Description FEE
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE
Building Permit 45
City Surcharge
PLAN CHECK NO:
46-blAr (S
G&L
THIS PERMIT AUTHORIZES ONLY THE WO KNOTED. THIS PERMIT COVERS WORKTO
Mechanical
t 0 DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUSUC
X
Grading
DOMAIN (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Revi—
PER ITAPPLICATION: INDAYS
PERMIT LIMIM 1 YEAR PFIOVR) D WORK 15 STARTED WITHIN 1800AYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
*APPLICAW. ON BEI LF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AMD SUOCESORS
Fire RevieW
Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FO DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Fire Inspection
Receipt #
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,
Non I IMIT I N ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION,
Recording Fee
Race
I HERE ACKNOWLEDGE THAT I HAVE READTHIS APPLICATION; THAT HE INFORMATION
LICATION APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUG.
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Tok AND,IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLAI ON OF THE LABOR CODE OF THE STATE OF WASHINGTON REwING TO
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B
FOR INSPECTION
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WOHKMEN>P"SARON.55I.RANCE AND RCW 182?�
'G_E/(
.113—t'.W .. -.E DATE SIGNED
(425)
771-0220
— A ffWION
T
1333
EXT 7T)
DATe
IT IS UNLAWFUL To USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORGINAL,FILE
YELLOWANSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK
-OWNER GOLD -ASSESSOR
04102 PRESS HARD -YOU ARE MAKING 5 COPIES
GREEN - ACCOUNTING
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FINAL PROJECT APPROVAL -FORM
DATE:
MEMOTO: PERMIT COORDINATOI;� BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE —
ENGINEERING DIVISION DATE —
PLANNING DIVISION DATE
PROJECT 0
SITE ADDRESS— 2
�ZODZ-Ob-72 ADB DATE INSPECTED —
PERMIT
DESCRIPTION OF WORK TO BE INSPECTED CA�C)P�
A rield 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
PERFORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITII CONDITIONS NOTED
u Copy of CONDITIONS given to owner/contractor by inspector
1
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractorby inspector
2.
3.
RE-INSpECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Datc�-- Sign_
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS ............
FOUNDATION:
Fooling .................
wait
Pler/Porch ................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground.............
Rough -in ...................
Commercial Final
HEATING:
Gas Test ............
Gas Piping ...........
Equipment .................
Commercial Final
EXTERIOR SHEATHING
NAILING ....................
FRAMING ............ ...........
FIRST FLOOR FRAMING.�.
I INS ULATIO N ...................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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