20050554.pdfDATE RECEIVED
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FPERMIT EXPIRES
CITY OF
EDMONDS
PERMIT
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ADDRESS
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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Inspection Required
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STATE LICENSE NUMBER EXPIRATION DATE
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Description
FEE
Description
FEE
Plan Check
State Surcharge
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VESTED DATE
Building Permit
City Surcharge
PLAN CHECK NO:
Plumbing
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Grading
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
Engr. Review
SEPARATE PERMISSION.
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 HE . R 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
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt
CALL
FOR INSPECTION
(425)
APPLICATION APPROVAL
�This application is not a permit until signed by the
Building Olficial or his/her Deputy! and roes are paid, and
receipt is acknowledged in space provided
1 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 BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENS!:2!�URANCE AND RCW 18:27.
OFFICIA SIG ATURE DATE
SIGNQ]� WNrR 01(��
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ATTENTION EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL - FILE YELLOW - INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 If IRC110. PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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Copy of CORRECTION NOTICE given to owner/contractor by inpec.tor
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RE -INSPECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
Date. Signature
1:temp:b1dg:fon-ns:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing .......................
Wall..........................
Pier/Porch .................
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Retaining Wall ...........
Slab Insulation ..........
171
PLUMBING:
�Underground .............
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Rough -In ...................
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Commercial Final ......
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HEATING:
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Gas Test ....................
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-Gas Piping .................
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Equipment .................
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Commercial Final .......
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EXTERIOR SHEATHING
NAILING ..........................
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FRAMING ........................
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FIRST FLOOR FRAMING...
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INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
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Ceiling Insulation . .......
A SHEETROCK NAILING
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SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY .....
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