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CITY OF EDMONDS USHE IT
UIMSER
CONSTRUCTION PERMIT APPLICATION JO SUITEJAPT#
ADDRESS 171
OWNER NAMEINAME OF BUS1111 EBB K? ALjf*-
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MAILING ADDRIEtS D FEE S
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NAME METER SIZE LINE SIZE FIXTURES I YES 13 NO 13
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CITY ZIP ITELEPHONE
11111IIIE81
FIRE REVIE�Eo .1
CITY ZIP TE EPHONE
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11OREUN101
STATE LICENSE NUMBER
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PROPE TY TAX ACCO PA CIEL NO.
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REMARKS
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CARPORT ROCKERY
FIR SPRINKLER
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NUMBER NUMBER OF
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STORIES UNITS
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DESCRIBE WORK TO BE DONE
REMARKS
DATE
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I OCCUPANT
GROUP
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INSPECTION REO'D
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FEE Description FEE
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Plan Check
State Surcharge
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Building Permit
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.2ity Surcharge
PLAN I DATE
Plumbing
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Mechanical
THIS PERMIT AUTHORUMS ONLYTHE ORKNOTED. THIS PERMIT COVERS WORK TO
C 8 DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON PUBLIC
2 THE
Grading
3 DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PE MITAPPLICATION: 180DAVS
Engr. Revievv
PERMIT LIMIT I Y EAR-PROVID 0 WORK IS STARTED WITHIN I so DAYS
Engr. Inspection
ACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICAur, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
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_REST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
IN INTE
EDMONDS, WASHINGION, ITS 011101AIS, EMPLOYEES. AND AGENTS FROM ANY AN.
Fire Inspection
Receipt #
ALL CLA MS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
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FROM THE ISSUANCE OF THIS PERMIT SSUANCE F THIS PERMIT SHALL NOT HE
DEEMED TO MODIFY. WAIVE OR HERB E ANY REQUIREMENT OF ANY CITY ORDINANCE
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0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
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Recording Fee
I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVE IS CORRECT.� AND THAT I AM THE OWNER. OR THE DULY UTHORIZED AGENT OF
T EOWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONISTRUC-
CALL
T1' "' """" "
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION 01 THE R ODE 0 THE STATE OF WASHINGTON RELATING TO
CURANCOE
FOR INSPECTION
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WORKMEN'S Cc N A�T�I AND RCW 18.27.
BIG NATUI
0 DATE
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RELEASED 8
ATTENTION
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U�%ER
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
�AS.E.on
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGI L- ILE - YELLM-INSPECTO
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109
PINK - - GOLD
04102 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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FINAL PROJECT APPROVAL FORM
TO:
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MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE —
ENGINEERING DIVISION DATE-
-PLANNING DIVISION DATE
PROJECT___t_�-ad'"d1dz1
SrIE ADDRES
PERMIT 1�1���ADB# PATE INSPECTED —
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
PE RMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITII CONDITIONS NOTED
a 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
2.
3.
RE-INSPECTrD OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign_
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACkS .....................
FOUNDATION:
Footing ...............
Wall ..........................
Pier/Porch
Retaining Wall
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in
Commercial Final
HEATING:
Gas Test ....................
Gas Piping ...........
Equipment .................
-Commercial Final
EXTERIOR SHEATHING
NAILING ..............
FRAMING ........................
FIRST FLOOR FRAMING...
INSULATION ............
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
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