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CITY OF EDMONDS
—CONSTRUCTION PERMIT APPLICATION
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SIGN AREA
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PROPERTY TAX ACCOUNT PAICIL NO.
100 5669 005,001 3
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Description
FEE Description FEE
Plan Check
State Surcharge
HEAT SOURCE
LOT SLOPE %
Building Permit
City Surcharge
PLAN CHECK NO: VE1!TE1 DATE
Plumbing
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Mechanical
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THIS PERMIT AUTHORIZES ONLY THE ORKNOTED. THIS PERMIT COVERS WORK TO
BE DOME ON PRIVATE PROPERTY ONLY, AM CONSTRUCTION ON THE PUBLIC
Giading
OMAIN ICURDS, SIDEWALKS. DRIVEWAYS MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERU;
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Engr._Revi"
PE MIT APPLICATION: 180 DAYS
PERMIT MUTE 1 YEAFI�PROVI ED WORK IS STARTEDVRTHIN I-ODAYS
Engr. 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
IN INTERESF. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHIN TON. ITS OFFICIALS. 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
9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY OnDINAN E
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Total Amt. US
. 0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee
Receipt #
I HERESY ACKNOWLE BE THAT I HAVE READ THIS APPLICATIOrL THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THC OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH Cl AND STATE LAWS REGULATING CONSTRUC.
CALL
"P A P'_R uMll �ipod by M.
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
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IN VIOLATION OF THE LABOR ODE OF THE STATE OF WASHINGTON RELATING TO
WORMERS QQMRF INSURANCE AND ACW I8ZT
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FOR INSPECTION
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DATE SIG ED
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7 71-0220
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ATTENTION FCT_
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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
ORIJAOL�FIELE - YELLOWASPEd011
PI N R - GO. -ASSESSOR
04/02 PRESS HARD -YOU ARE
MAKING 5 COPIES
GREEN - ACCOUNTING
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FINAL PROJECT APPROVAL FORM
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FROM: FIRE DEPARTNIENT DATE
A U 1 ENGINEERING DIVISION DATE
DIVISION DATE —
PROJECT '-3 - b (72'00,- 5Y5 ro-- M5 /��V6 /\J
SITE ADDRESS 77-2L Z/OrH _21 s�LJ
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DESCRIPTION OF WORK TO BE INSPECTED
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
PERFORMANCE BONDS and the granting of:
X.- GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
a Copy of CONDMONS given to owner/contractorby inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contractor by inspector
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..........................
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Pier/Porch .................
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Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
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Underground
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Rough -in ...................
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HEATING:
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Gas Test ..................
Gas Piping .................
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EXTERIOR SHEATHING
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NAILING .......... ...............
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FRAMING ..........
FIRST FLOOR FRAMING...
INSULATION ...................
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Floor Insulation
Wall Insulation ...........
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Coiling Insulation
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SHEETROCK NAILING
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SPECIAL INSPECTION
MISCELLANEOUS
FINAL APPROVAL FOR
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OCCUPANCY ..............