20040395.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE___j
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180DAYS
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PERMIT LIMIT.''I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
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LU IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS VHE CITY OF
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EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
IMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTIY OR INDIRECTLY
ALL CLA
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF I HIS PERMIT SHAI L NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMEN1 OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION'
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DU& AUTHORIZED AGENI OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
1ION, AND IN DOING THE WORK AUTHORIZED IIIEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WOIIKMEN'S COMPENSAT19N-lNSURANCE AND RCW 16 27.
DATk SIGNED
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FEE Description FEE
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APPZICATION APPROVAL
I iiis application is not a pennit until signed by lhe
BmIding 011icial or hisiller Deputy. and Fees are paid, and
ieceipt is acknowledged tit space provided.
OFFICIALS SIGNAIURE DATE
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�SFD DATE
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IT IS UNLAWFVL TO USE Oil OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL Oil A CERTIFI- ORIGINAL IN ECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER - GOLD - ASSESSOR
09!03 PRESS HARD -YOU ARE MAKING 4 COPIES
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Enor. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
7Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
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FINAL PR03ECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASESIGN
ENGINEERING DIVISION DATE
PLM%SE SIGN
PLANNING DIVISION DATE
PLEASESIGN
PROJECT/9X-/,,,
SITE ADDRESS '7 1 1!2 1.11444"
PERMIT —ADB#_________PATEfNSPECTED a-/
DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine compliance with -approved plans. Filial approval
denotes that there are no objections from the above signed Department to the release of
PERFORMANCE BONDS and the granting of :
A GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
El Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:forms:ocaprv1 3/25/04
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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:
GasTest ....................
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 FOR
OCCUPANCY ..................
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