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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNn;ME DF USINESS
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REMARKS
—ITRACTOR RESPONSIBLE FOR EROSION CONTROLIDNAINAGE
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VALUATION
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Description FEE Description FEE
Plan Check State Surcharge Iq 51) 1
G�ING % LOT SLOPE %
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Building Parrnit City Surcharge
VESTEG DATE
Plumbing
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THIS PERMIT A ORrZES ONLY THE WORK NOTED. "IS PERMn COVERS WORK TO
C PRIVATE PROPERTY ONLY ANY CONSTRUCTION ON THE PU BUC
BE DONE OF
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DOMAIN ( URBS. SIDEWALKS, DRIVEWAYS MARQUEES, 0C.i MLL REOUIRE
SEPARATE PERU;6610N.
Engr. Review
PERMITAPP=JON: 1W.AYS NDAYS
PERMIT UMM. I YEAR - PROVI ED WORK 13 STARTED WITHIN I 5 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Fire RevaW sit
CD
'APPLICANT ON BEHALF OF HIS OR HER SPOUSE. HEIRS, AS.1.�GIB AND SUCC12S.RS
DEFEND AND HOL LESS THE C1 OF
IN INTE EST. AGREES TO INDEMNIFY,
WASH DAG 3 FROM ANY AND
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EDMONR
Fi re Inspection Receipt #
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ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THEISSUANCE I PERMIT ISSUANCE OF THIS P"MITSNALIL NOT BEE_
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'.HE ELY A ION: THAT THE INFORMATION
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ATTENTION
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IT IS UNLA�,EUI_jo WE OR OCCUPY A ByiLDING OR STRUCTURE UNTIL
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FINAL ?ROXECT APPROVAL FO- -d
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIR DEPARTMENT DATE
ENGINEERING DIVISION DATE�--
PLANNING DIVISION DATE --
PROJECT 1A Z &1-44AZC-
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PERMIT �8�.ADB#_----DATE INSPECTED-,��— �Q?
DESCRIPTION OF WORK TO BE INSPECTED—=/-I--
A fleld 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,
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
t3 Copy ofCONDITIO11TS given to owner/contractorby inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contractor by inspector
1.
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..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ..................
Commercial Final
HEATING:
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final
E)ITERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
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OCCUPANCY ..................
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VALUATION
$
Description
FEE
Description
FEE
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state surcharge
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HEAT SOURCE
Building Permit
1-U-1
city surcharge
PLAN CHECK NO:
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BE DONE I" p,, MOPE, I", I CONST"RUCTION ON THE PU BUD
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Grading
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.. SEPAMTEPERMISSiON.
Engr. Review
PEFUR APPLICATI - DAYS
R
PERMIT LIUM. I YEAR - PROVIDED WOON: IS I STARTE"W'"'"N "BDA'S
Engr. InSpection
SEE BACK OF PINK PERMIT MR MORE INFORIMATION
Fire Review
'50—
Plan Chk. Deposit
01 BEHALF 0 HIS OR HER SPOUSE, RUSS. ASSIGNS AN. SUCCESORS
IN INTEREST AGREES TO INDEMNIFY, 311110 AND HOW HARMLESS THE CITY OF
NY D
AND AGENTS MOM A AND
Fire Inspe fion
-
Receipt N
EDMONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES,
CLAIMS FOR DAMAGES OF WHATEVER MATURE. MSING DIRECTLY OR INDIRECTLY
MOM THE ISSUANCE OF THIS PERMR. ISSUANCE OF;�S PEFj1VMff SHALL TOE
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Recording Fg�
Receipt
I HEREBY ACKNO7 E THAT I t4VE READ THIS APPUCATION; THAT THE INFORMATION
THE OWNER, THE AUTHOMZED AMEW OF
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,
( , _r PPLICATION APPROVAL
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GIVENO e.DG G I AM -DULY
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'FIC IG E DATE
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