20050171.pdfFDATE �RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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NUMBER
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NAME/SUBDIVISION NO.
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LOT NO,
LID NO.
LID FEE
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCIPApproveo
RW Perma Required
EXISTING �� PROPOSED
Street Use Pe(niot Required
Inspection Required
Sidewalk Requirw
REQUIRED DEDICATION FT
Undergmund
METER SIZE
LINE��
NO. OF FIXTURES
PRV REQUIRED
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REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
LICENSE NUMBER EXPIRATION DATE CHECKED BY
'RTY TAX ACCOU14T PARCEL NO.
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Description_
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Plan Check
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LOT SLOPE%
DATE
Building Permit
PLAN CHECK NO:
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Grading
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
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 REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
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
OCCUPANT
GROUP
CONSULTANT
OCCUPANT
LOAD
FEE
Description
FEE
State Surcharge
City Surcharge
Base Fee
CALL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
W RSON WILL BE EMPLOYED
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ION AND IN DOING THE WORK AUTHORIZED THEREBY, NO PE FOR INSPECTION
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771-0220
Plan Chk. Deposit
Receipt ft
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a perinit until signed by the
Building Official or his/her Deputy and Fees are paid, and
receipt is acknowledged in space provided
FICCALS SIGNA URE DAT
L SEr DATE
ATTENTION " r-A 1. -11000 1 AU/ I 1101?
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAJ LE YELLOW IN(PI)CTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110. PINK - 641713 GOLD - ASSESSOR
10104 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
PLWE SIGN
ENGINEERING DIVISION DATE
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PLANNING DIVISION DATE
PLEASESIGN
PROJEC
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SITE ADDRESS —
PERMIT ADB# DATEINSPECTED
DESCRIPTION OF WORK TO BE INSPECTED
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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
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
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
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2.
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fomis:ocaprv1 3/25/04
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FINAL PROJECT XPPROVAL FORM
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DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASE SIGN
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign___,
ocaprvi.doc.l:temp:bldg:fonnsIO/O1
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
GasTest ....................
GasPiping .................
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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