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I DATE RECEIVED
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CITY OF EDMONDS
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CONSTRUCTION PERMIT APPLICATION
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NAME
METER SIZE I LINE SIZE
I NO. Of FIXTURES PRV REQUIRED
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CITY ZIP ITILEIPHONE
REMARKS
OWNERICONTRACTOR RESPONSIBLE
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DESCRIBE WORK TO BE DONE
EMARKS
PROGRESS INSPECTIONS PER USC 1108/11FINAL INSPECTION REOV
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Description
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FEE Description FEE
Plan Check
State Surcharge
___�EAT SO —URGE GLAZING LOT SLOPE %
Building Permit
City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT ALIT VORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
b 11111,111" P111 PROPERTY ONLY 11 INSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURB$, SIDEWALKS, DRIVEWAYS
Pa.., MARQUESS, ETC.) WILL REQUIRE
SEPARATE SSION.
PF MITAPPLICATIOW UNDAYS
Engr. Review
PERMIT Usurc I YEAR - PAOVID D WORK IS STARTED WITHIN I so DAYS
Engir. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-APPLICANT ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
1. INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
a EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
ALL CL MIS FOR DAMAGES OFWHATEVER NATURE, ARIS NO DIRECTLY OR INDIRECTLY
Fire Inspection
I
Recelpt #
---
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE F THIS PERMIT SHALL NOT BE
D EMBED TO MODIFN!. WAIVE OR REDUCE ANY REQUIREMENT OF ANY C TY ORDINANCE
Landscapeinsp.
Total Amt. Due
i
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.�
—
Recording Fee
Receipt #
I HEREBY ACKNOWLE BE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMAT
AP ATI NAP ROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER, 08 THE DULY AUTHORIZED AGENT OF
T E OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC�
CALL
nal Par." .,11aignodbyMa
P, I. ,,, 1, a
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
OF TH LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Is or 151 as a,, paid, and
Bull, n "' op,ty: Fe
al—k—udg.din Ca Idad�
4410-L-IT-ION
a COMPEN ANON INSURANCE AND RCW 18,27.
�IkTURE (OWNER O�A�NR DATE SIGNED"
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771-0220
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IVEA19C, BY DATE
A17ENTION
Off 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
OR GINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK�OAVNEIR GOLD -ASSESSOR
04102 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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MEMOTO: PERMIT COORDINATOR, BUILDING DIVISION
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ERING DIVISION DATE
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DESCRIPTION OF WORK TO BE INSPI ECTED
A field inspection wa a 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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a Copy of CORRECTION NOTICE given to owner/contractor by inspector.
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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:
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Wall ..........
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Pier/Porch .................
Retaining Wall ...........
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Stab Insulation ..........
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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 ....................
Gas Piping .................
Equipment ...............
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EXTERIOR SHEATHING
NAILING ............. ...........
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INSULATION ...................
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Ceiling Insulation
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SHEETROCK NAILING
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SPECIAL INSPECTION
MISCELLANEOUS
FINAL APPROVAL FOR
OCCUPANCY ..................