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CITY OF EDIVIONM
CONSTRUCTION PERMIT APPLICATION
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Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE BLAZING % LOT SLOPE %
Building Permit
'56— City Surcharge
PLAN CHEC!?A
Plumbing
THIS PERMIT AUTHORIZES ONLY THE ORK NOTED. THIS PERMIT COVERS WORK TO
Mechanical
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0 DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON EPUB
Grading
D=N (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, rTC.) WITLLH REQUIURCE
SEPARATE PERMISSION.
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PE MITAPPLICATION: 180DAYS
PERMIT LIMIT I YEAR -PROVIDE WORK IS STARTED WITHIN 180DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
—PLICANT, ON BE-11 01 HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUGCE1O11
Fire Review
Plan Cbk,Depmft
IN INTEREST AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON ITS FFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Fire Inspection
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FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED
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TO MODI WA IE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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NOR LIMIT IN AM WAY THE CITYS ABILITY TO ENFORCE ANY OHDINANCE PROVISION.-
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Recording Fee
Receipt N
I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THAT THE INFORMATION
APPLICATION 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 CONSTRUC.
CALL
applicand.is noiaparcult until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THERIElly, No PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMENS COMPENSATgE.KSUMNCE AND HOW 46. 7.
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ding C frond or his"of Deputy; and Fees are paid, and
FOR INSPECTION fad� )pits acknollodUral In pace pmided.
a R DATE 87ED
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OFFICIALS SIGNATURE DATE
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771-0220
'VVtSED 6Y DATE
A 7FENION
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-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
ORIGINAL - FILE - YELLOIAT!'INSPFC
PINK -OWNER GOLD -ASSESSOR
04102 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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ENGINEERING DIVISION DATE
PLANNING DIVISION DATE
PROJECT
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PERMIT 0736) ADB#--DATEINSPECTED—L:::�(V�
DESCRIPTION OF WORK TO BE INSPECTED 4- 0 6
A field inspection was conducted to determine fmal 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 VqM 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
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign__
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RECORD OF IN�PECTIONS
INSPECTOR
DATE APPROVED
SETBACKS
FOUNDATION:
Footing......................
Wall_ .......................
Pier/Porch
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Retaining Wall ...........
Slab Insulation ..........
0
PLUMBING:
Underground .............
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Rough -in ............
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Commercial Final
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HEATING:
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Gas Test ....................
Gas Piping .................
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Equipment
Commercial Final
EXTERIOR SHEATHING
NAILING ..........................
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FRAMING ......................
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FIRST FLOOR FRAMING
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INSULAT16N ...................
Floor Insulation
Wall Insulation ...........
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Ceiling Insulation
SHEETROCK NAILING
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SPECIAL INSPECTION
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ...............
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