20050995.pdfDATE RECEIVED / o
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PERMIT EXPIRES
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ROCKERY
(TYPE OF Slum
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NUMBER
NUMBER OF
OF
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DESCRIBE WORK TO BE DONE
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LUMBIN MECH
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LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT
L/R SIDE REAR
CO NCE OR
CHANGE OF USE
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PARKING
LOT AREA
PLANNING REVIEWED BY
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REMARKS
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FIRE SPRINKLER
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D I�
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VALUATION
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
It BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180DAYS
LIMIT; I YEAR WORK
PERMIT. -PROVIDED IS STARTED WITHIN 180DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
OAPPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY Oil INDIRECTIY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF 1141S PERMIT SHAIA N01 HE
Landscapolnsp.
Total Amt. Duo h1i
9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQIJIIIEMENI OF ANY CITY ORDINANCE
'I NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION'
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Fee
Receipt #
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Recording
1 HEREBY ACKPPWLEDGE THAT I HAVE READ TIIIS APPLICATION, THAT TIIE INFORMATION
APPLICATION APPROVAL
GIVEN IS JEC - AND THAT I AM TIIE OWNER, OR TIIE DULY AUTHORIZED AGENT OF
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THE OWNER 1 3 E TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRLIC-
CALL
this application is not a pennit until signod by tho
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TION; AND I UOI THE WORK AUTHORIZED TliEREBY. NO PERSON WILL BE EMPLOYED
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Building 011icial or his/hor Deputy. and Foos rao Paid, and
I N VIOLAT )F HE LABOR CODE OF TliE STATE OF WASIIINGTON RELATING TO
FOR INSPECTION tocuipt Is ocknowlodged in bpaco Tuovidod
WORKME ENSATION INSURANCE AND RCW 10 27.
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FFi SIGNATUIIF I IF.
Sl N:A DATE. SIGNED
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nRERORAGE
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EXT 1333
IT IS LIN WFUL TO USE OR OCCUPY A BUILDING on STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL VILF YELLOW INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK OWNER GOLD ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES . GREEN ACCOUNTING
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FINAL PROJECT APPROVAL FORM
TO:
DATEL:
ME -MO TO: PERMIT COORDINKrOR, BUILDING DIVISION
FROM: FIRE, DEPARTMI, N'r DATE
PLEASE
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PLANNING DIVISION DATE
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PROJECT
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DESCRIPTION OF. WORK TO BE INSPECTED 4;V741 -71Y
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A field inspection was conducted to determine compliance 'with -approved plans. Final app ioval:
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'denotes that * there are no objections from the above signed Department to the release of
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PERFORMANCE BONDS and the granting of
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GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to owner/contractOr by inspector.
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
El Copy ofCORRECTION NOTICE given to owner/contractor by inpector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signattife
1: let np: 1) Idg: 1bnns:kaprv1 3/25/04
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .... I .................
FOUNDATION:
Footing . ......................
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Wall.......................... . .
Pier/Porch ..... .............
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Slab Insulation ..........
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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
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NAILING .... ......................
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FRAMING ........................
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FIRST FLOOR FRAMING...
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INSULATION .... i ..............
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Floor Insulation ........
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Wall Insulation ...........
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Ceiling Insulation .......
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SHEETROCK NAILING
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SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
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OCCUPANCY_s ................
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