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DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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PERMIT EXPIRES
USE PERMIT
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NUMBER
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JOB SUITE/APT#
ADDRESS
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PLAT NAMEISUBDIVISION NO. LOT NO LID NO.
LID FEE $
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PUBLIC RIGI IT OF WAY PER OFFICIAL STREET MAP
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EXISTING — PROPOSED
Street Use Permit Roq'd 13
Inspection Required
Sidewalk Required
CITY
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REQUIRED FT
DEDICATION
Underground
Winng required
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METER SIZE
NO. OF FIXTURES
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PRV REQUIRED
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ADDRESS REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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ENGINEERING REVIEWED BY tDATE
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FIRE REVIEWED BY DATE
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STATE LICENSE NUMBER EXPIRATI C EC ED 13Y
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PROPERTY TAX ACCOUNT PARCEL NO.
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RESIDENTIAL
ADDITION
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COMMERCIAL
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MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
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RETAINING WALL
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AREAS
NUMBER 4�V—
LOT SLOPE %
VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
to PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 1130 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
to 'APPLICANT. ON BEHALF OF HIS OR FIER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS rHF CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIFFECRY OR INDIRFCRY
FROM THE ISSUANCE OF *THIS PERMIT. ISSUANCE OF IHIS PERMIT SHALL NOT 13E
_j DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENI OF ANY CITY ORDINANCE
01 NOR LIMIT IN ANY WAY THE CITYS A131LIlY TO ENFORCE ANY ORDINANCE PROVISION'
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
TION, AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL 13E EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING 70
WORKMEN'S COMPENSATION INSURANCE AND RCW 18 27.
DATE SIGNEP
VARIANCE OR CU
SEPA REVIEW
COMPLETE EXEMPT
EXP
LOT COVERAGE
ALLOWED PROPOSED
PARKING
REQ'D I PROVIDED
REMARKS
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CHECKED BY I TYPE
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REQUIRED SETBACKS (FT)
PROPOSED SETBACKS (FT)
FRONT SIDE REAR
FRONT LIR SIDE REAR
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LOT AREA
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DATE
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SPECIAL INSPECTION JAREA
REQUIRED [] YES
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OCCUPANT
GROUP
OCCUPANT
LOAD
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REMARKS z
PROGRESS INSPECTIONS PER UBC I 08/1FINAL INSPECTION REQ'D ' S
VALUATION
Description
FEE
Description
FEE
Plan Check
St ate Surcharge
Building Permit
City Surcharge
Plumbing
Base ee
Mechanical
Grading
Engr, Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
IM
Fire Inspection
Receipt 0
Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt #
APPLICATION APPROVAL
CALL
I hisapplication is not a pennit until signed by the
Building 011icial or his/her Deputy and Fees are paid, and
FOR INSPECTION
receipt is acknowledged in space provided.
OFFICIAL S SIGNAI Uf�- DAT F
(425)
771-0220
HGI1SFD BY uAA
A17ENTION x 1 1333 L", , - '! -1
L 1/11'A , I �'
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 21
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- OIWONAI FILE - N'LLLCkV-INSPECTO1I
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 Pl'-m - GOLD-ASSESSOFI
0903 PRESS HARD -YOU ARE MAKING 4 COPIES
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLFASE SIGN
;�k,, Ir I -)Le— �Mf L/L'/1_,dzENGINEERING DIVISION DATE-14bV
PLEASESIGN
PLANNING DIVISION DATE'
MY -ASH SIGN
PROJECT -&2
SITE ADDRESS 70
PERMIT# 2— eW— KO Z 9 (�2 ADB# *DATEINSPECTED
DESCRIPTION OF WORK TO BE INSPECTED fn /-,-I (I r—
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:
-Z GRANT FINAL PROJECT APPROV. AL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
a Copy of CONDITIONS given to owner/contractor by inspector
1.
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
a Copy of CORRECTION NOTICE given to owner/contractor by inspector
1 .
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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.......................... z
Pier/Porch .................
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Retaining Wall ...........
Slab Insulation ..........
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PLUMBING:
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Underground ............. M 0
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0 0
Rough -In ................... C
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Commercial Final ......
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HEATING: C
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Gas Test .................... x
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Gas Piping ................. 0 -n
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Equipment .................
M M
Commercial Final ....... 0 —
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EXTERIOR SHEATHING 0 ITI
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NAILING .......................... Cl)
Q 0
FRAMING ........................ Z r-
FIRST FLOOR FRAMING ...
INSULATION ...................
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Floor Insulation .........
Wall Insulation ........... Cl)
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Ceiling Insulation ....... 0
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SHEETROCK NAILING ... ------------- 0
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SPECIAL INSPECTION ... ------------
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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