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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: 180 DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. 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 PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENTOF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
I HEREBY ACKNOW'_EDGE 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 /%No STATE LAWS REGULATING CONSTRLIC-
TION; AND IN DOING TI IE W�� UTI IORIZED THEREBY, NO PERSON WILL BE EMPLOYED
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IN VIOLATION OF THE 0 'C�OPE OF THE STATE OF WASHINGTON RELATING TO
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PROGRESS INSPECTIONS PER UBC108/IBC109/IRC109 FINALINSPECTION REQ'D F3
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VALUATION
Description
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Building Permit
City Surcharge
Plumbing
Base Fee
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Total Amt. Due
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Rec pt #
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CALL
FOR INSPECTION
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771-0220
APPLICATION APPROVAL
This application is not a permit until signed by the
Building 011icial or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
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01 104ALS SIGNATURE DATE
RFLEAdrD BY 'PATE
ATTE"TIQN E)ff 1333
IT IS UkAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILA FINAL I
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/]BC110/IRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL -FILE YELLOW -INSPECTOR
PINK -OWNER GOLD -ASSESSOR
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MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
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ENGINEERING DIVISION DATE
PLEASESIGN
PLANNING DIVISION DATE
PLEASE SIGN
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PERMIT #
DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine compliance with -approved plans. Final approval
denotes that there are no objections from the above signed Department to the release of
PERFORM-ANCEBONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
Copy of CORRECTION NOTICE given to owner/contractor by inpector
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
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SETBACKS .....................
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Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
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HEATING:
GasTest ....................
Gas Piping .................
Equipment .................
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EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
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INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
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PERMIT EXPIRES
CITY OF EDMONDS
USE ? PERMIT
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NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB
SUITE/APT#
ADDRESS
OWNER NAMEINAME OF BUSINESS
PLAT NAMEISUBDIVISION NO. LOT NO,
LID NO.
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MAR ING ADDRESS
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Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
1= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2 Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE 4Pz#-1V% 1;% 14 ift a r Ir 10
SEPARATE PERMISSION. Engr. Review
cc IMIPIC— r.
W PERMIT APPLICATION: 180DAYS
PERMIT LIMI1' I YEAR - PROVIDED WORK IS STARTED WITHIN 1130 DAYS Engr. Inspection
SEE B.ACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF His bR HER SPOUSE. HEIRS, ASSIGNS AND SUCCEsdRS Fire Re\�ew Plan Chk. Deposit
IN INTEREST, AGREESJO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection
0: Receipt #
4 ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF IHIS PERMIT SHALL NOT BE
Landscapelnsp. Total Amt. Due
_j DEEMED TO MODIFY� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
101 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION'
Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER. OR THE OU& AUTHORIZED AGENr OF APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC. CALL This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTPORIZED THEREBY. NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR COP'E OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION re.ceipt is acknowledged in space provided
WORKMEN'S_.5QMEgNSATION INSURANCE AND RCW 18.27.
9FFI�IA_r�ZIGN T�,RE DATE
SIGNATUFfE �OWNER O� ...... DATE SIGNED 25)
(4
771-0220 RELEASED BY DATE
AT'T�NTION EXT 1333
IT(S,UNLAWFU�,_�O 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 I ASSESSOR
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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 FOR
OCCUPANCY ..................
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