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CITY OF EDMONDS 77:
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CONSTRUCTION PERMIT APPLICATION ADDRESSF,4/�
OWNER NAME/NAME OF BUSINESS PLAT NAME/SUBDIVISION NO
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REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONIROLIDRAINAGE
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FIRE REVIEWED BY
VARIANCE OR CU
SEPA REVIEW
COMPLETE EXEMPT
EXP
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ALLOWED PROPOSED
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PROGRESS INSPECTIONS PER UBC I 08/FINAL INSPECTION REQ'D
VALUATION
-------- I ------ V_
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building - Permit City Surc]harge
HECK NO: VESTED DATE Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
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PERMIT APPLICATION: 180 DAYS
L PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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n 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
S I FY, DEFEND AND HOLD HARMLESS THE CITY OF
uu IN INTEREST, AGREES TO INDEMNI
-1 _R Receipt #
rE EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND Fire Inspection 2�
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ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIREC I TY OR INDIRECI LY
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F M 1 F S I F I HIS PERMIT SH —C 7-
R E ISSUANCE OF THIS PERMIT. ISSUANCE 0 ALL NOT BE
ROM I H Landscapelnsp. Total Amt. Due �1_,>
M To Mo 0 LICE ANY REQUIREMENT OF ANY CITY ORDINANCE
j DEEMED TO MODIFY, WAIVE OR RED OVISION.'
D C 0 L M I r Bit-11Y TO ENFORCE ANY ORDINANCE PH
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NOR LIMI r IN ANY WAY THE CITYS A Receipt N
x — Recording Fee �?_
I HEREBY ACKNOWLEDGE THAT I HAVE READTHIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF I his application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC� CALL Building Official or his/tier Deputy: and Fees art, paid, and
TION; AND IN DOING TRE WORK AUTHORIZED TIIEREBY. NO PERSON WILL BE EMPLOYED receipt is agknowledged in space provided.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTI
WORKMEN'S cgWpENqATION INSURANCfkND RCW IB 27. IA1 S SIGN RF DATE
DATE S)GNED (425)
SICA1 R - WN`ER 0 GENT) 771 0
1-0220 -[.EASED BY DATE
'Ar� rf Ik ll*tZlie 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- ORIGINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR
09103 PRESS HARD -YOU ARE MAKING 4 COPIES
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FINAL PR03199T-,�PMCWAL FORM
MAR 33 0 2004 TO:
DEVELOPMENT SERVIrES CT - R -
cITY OF EDMONDS DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
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FROM: FIRE DEPARTMENT DATE
PLEASE SIGN
ENGINEERE*4G DIVISION DATE —
PLEASE SIGN
PLANNING DIVISION DATE
PLEASE SIGN
PROJECT AIL (LIL Lu-� r
SITE ADDRESS
ADB#______--PATE INSPECTED 3
PERMIT
DESCRIPTION OF WORK TO BE INSPECTED U 444j'-s"5C
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:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
o Copy of CONDITIONS given to owner/contractor by inspector
1 .
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
o Copy of CORRECTION NOTICE given to owner/contractor by inspector
1 .
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Si
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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 ...
MISCELLANEOUS ..........
FINAL APPROVAL FQR
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