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PERMIT E
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PLAT NAME/SUBDIVISION NO
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ad MAILING ADDRESS
10 4m
PUBLIC RIGHT OF WAY PER'O"IFFICIAL STREET MAP
EXIST ING — PROPOSED
RE—IRED DEDICATION— PT
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CITY ZIP
TELEPHONE
-77/1
NAME
METERSIZE
LINE SIZI
PRV REOUIRED
IES 0 NO 0
ADDRESS
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY ZIP
9-2io--49-5
TELEPHONE
-574-4
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EN.—HIN. REVIEWEDIDATE
Is ADORM'l
PIPE REVIEWED BY DATE
CITY ZIP
TELEPHONE
75� 0 S-C.4
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STATE LICENSE NUMBER EXPIRATION DAIS
VARIANCE OR CU
SHORELINE OR AOB9
INSPECTION
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POST
SEPAREVIEW
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SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
PROPERTY TAX ACCOUNT PAR
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EXP I
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LOT COVERAGE
REOUIRED SETBACKS (FT)
PROPOSED SETBACKS LIFT)
COMMERCIAL ci C MPLIANCE OR
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ALLOWED PROPOSED
FRONT SIDE HEAR
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FRONT UR SIDE REAR
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/0'�40DITION
CHANGE OF USE
PARKING
LOT AREA
PLANNING REVIEWED BY DATE
*NEMODEL n APARTMENT C3 SIGN
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IROVIOED
REPAIR 0 rRAIING CY., C] PENCE
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(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
CHECKEDBY
ITYP=ION q7l COURANT
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NUMBER
OF
UM BIT
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'NITS OF
S ECIALINSPECTOR
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OCCUPANT
o STORIES
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JAREA
EOUIRED C3 YES
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DESCRIBE WORK TO 65 DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION
VALUATION
FEE
JE
PLAN CHECK FEE
/�rCE
BUILDING
ATE
PLAN CHEC7,�
PLUMBING
IIESTED
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVE MARQUEES, FTC,) WILL REOUIR E
WP S'
GRADINGIFILL
EAYR
S E PA R AT E MISSID N.
STATE SURCHARGE
PERMIT APPLICATION; IBQ DAYS
PERMIT LIMIT I YEAR PROVIDED W RK IS STARTED WITHIN 18D DAYS
SEE BACK Oi PINK PERMIT FOR MORE INFORMATION
FEES
F HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
�Tr�lNSFECTION FEE flA
5c) I
;ARPLICANTONBEHAL
N NTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAP NO
2 EDMONDS, WA HINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANYAND
INSPECTION FEE
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR IND RECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
D EMED TO MODIFY. WAIVE OR REDUCE ANY 8ECU18EMENT OF ANY CITY ONO INANCE
PLAN CHECK DEPOSIT
0 NOR LIMIT IN ANY WAY THE CITY S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.�
TOTAL AMOUNT DUE
h9- '75--1
I HERE Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THAT THE INFORMATION
0
GIVEN IS CORRECT, AND THAT I T e INNER 0. THE BULY AUTHORIZED AGENT 11
APPLICATION APPROVAL
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THE HER E�IC.0 ' 'TH CITY AND STATE LAWS R GULATING CONSTRUC.
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IS H.RoZEU THEREBY. No PERSON WILL BE EMPLOYED
T'CN . ANUV -W K fH
CALL
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I LA .11 E 01 THE STATE .1 WASIAINDTON RELATING TO
FOR INSPECTION ...,pl Is .,,kAFwk,,Jg.d,n I,P,,dld.d
'H� IN NCE AND RCW 18,27.
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OIFICIAL. E—A TURE
DATE SIGNED
(425)
771-0220
DATE
�fION
ATTt
EXT/333
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IT IS UN AWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
, N A,
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE YELLOW - 14SPECT6R
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK -OWNER GOLD ASSESSOR
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FINAL PROJECT APPROVAL FORM
TO.
DATE-
IvMMO TO: PERIYffr COORDINATOR, BUILDING DIVISION
FROM: FIR DEPARTWIENT DATE,
E DIVISIONDATIE,_
PLANNING DIVISION DATE
srrEADDREss q60 A-�-c
PERmrr # 2oo?_- 19 7 3-�'- ADB# —DATEINSPECTED
DESCRIPTION OF WORK TO BE INSPECTED /Z:
A field 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
PE RFORMANCE BONDS and the granting of:
--X—GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
u Copy of CONDITIONS given to owner/contractor by inspector
1.
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
ci Copy of CORRECTION NOTICE given to owner/contractorby inspector ZZO
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date_ Sign_
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ....................
FOUNDATION:
Footing ......................
wall ..........................
.................
zPier/Porch
Retaining Wall....
Slab Insulation
PLUMBING:
Underground
0
.............
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Rough -in ...................
0
0
Commercial Final
IT
HEATING:
Gas Test ....................
Gas Piping .................
Equipment .................
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Commercial Final
ITI IT!
EXTERIOR SHEATHING
NAILING ..........................
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FRAMING
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41 A
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FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation
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Wall Insulation ...........
3:
Ceiling Insulation
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SHEETROCK NAILING
SPECIAL INSPECTION
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IT
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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