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PERMIT EXPIRES
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CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
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OWNER NAMFrNAME OF BUSINESS
PLAT NAMErUBDIVISION N LID NO,
LID FEE S
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THIS PERIll AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUC710H ON THE PUBLIC
STO L our..
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATEPERMISSION.
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SEEz1a ACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICA 0 BEHAL HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
arn,
Traffic Mitigation
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IN INTEREST, AGREES TO It DEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMOND% WASHINGTON. I OFFICIALS, EMPLOYEES. Alto AGENTS FROM ANY AND
Fire Review
ALL CLAIMS FOR DAMAGES F WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERUM ISSUANCE OF THIS PERMIT SHALL NOT BE
Fire Inspection
DEEMED TO MODIFY' WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROl
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I HEREBY ACKNOWLED 15 THAT I HAVE READ THIS APPLICATION; T14AT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHOR ED AGENT OF
THE OWNER. I AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
rFOR,NSPECT,(
TION; AND,IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLAT ON OF THE LABOR CODE OF THE STATE OF WASHINGTON SEWING TO
WORKMENS COYENSATION INSU CE AND RCW 1827�
(425)
771-0220
ATTENTION
EXT 1333
IT IS UNLAWFUL TO USE On OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
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Recording Fee
City Surcharge
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APPLICATION APPIfROVAL
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APPROVED By ENGINEERINq
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Date:
FINAL PROJECT APPROVAL FORM
TO:
DATE:
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FROM: FIRE DEPARTWNT DATE—
FI) C., L- 1A oz-�t ENGINEERING DIVISION DATE
DIVISION DATE—
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DESCRIPTION OF WORK TO BE INSPECTED—_]E1#,i4-\
A field inspection wits 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
PERFORMOCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL wrm CONDITIONS NOTED
u Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
t3 Copy of CORRECTION NOTICE given to owner/contmctor by inspector
2.
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R&INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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RECOR6 OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing... ...............
Wall..........................
Pier/Porch .. ...............
Retaining Wall ...........
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Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in ...................
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HEATING:
Gas Test ..............
fill
Gas Piping .................
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Equipment . ..............
Commercial Final
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EXTERIOR SHEATHING
NAILING
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FRAMING .......................
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INSULATION ........... 0 -c9s
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SHEETROCK NAILING
SPECIAL INSPECTION
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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