20040661.pdfDATE RECEIVED
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USE PERMIT
CITY OF EDMONDS ZONE N U M B E R
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS
OWNER NAME/N�ME OF BUSIN S LID NO.
C 11 PLAT NAME/SUBDIVISION NO . LOT NO. LID FEE $
IMAILING ADDRESS I ESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required
Street Uso Permit Roq'd
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NAME I I YES 13 NO 13
REMARKS
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ADDRESS OWNER11ZONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CITY ZIP ITELEPHONE
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NUMBER
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NUMBER
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1PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINALINSPECTION REO'D F3
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pURSUANT TO UPC 605.2
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PLAN CHECK NO:
VESTED DATE
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
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
2APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMI1 SHALL NOT BE
DEEMED TO MODIFY� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CIIYS 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 DULY AUTHORIZED AGENT OF
APRFSSUREREGUIATORVALVE (PRV)
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VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Base Fee
Mechanical
Grading
Engr. Review_
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt
Landscapelnsp-
Total Amt. Due
Recording Fee
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Receipt Y
APPLICATION APPROVAI!
thisa licalion is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- VV
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED CALL Building 011icial or his/tier Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION . rj.�cujpj is acknowledged in space provided.
WORKMEN'S �PIE�SATION INSURANCE AND RCW 18.27. or 1. Al -Se S MGA[ RE DATE
SIGNATURE((OWNETI 6R AGENT) DAT E I SIGNED (425)
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(VI k � -c" L, - 771-0220 RELEAS
ATTENTION EXT-1483
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL I
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OFOCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110-
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
BY
ORIGINAL - FILE YELLOW - INSPECTOR
PINK . OWNER GOLD - ASSESSOR
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLPASE SIGN
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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
0 Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
a Copy of CORRECTION NOTICE given to owner/contractor by inspector
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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*y ..............
4
Rough -In .................
commercial Final
HEATING:
!Gas TesV.'.....'.'.: ..... ....... ------
Gas Piping .................
Eclyipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING..........................
FRAMING........................
Fj1f,1ST FLOOR FRAMING ...
INSULATION ...... .
Wall Insulation ........... --------------
Ceiling insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS .......... ---------------
FINAL APPROVAAW
..............
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