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CITY OF EDMONDS NUMErER
CONSTRUCTION PERMIT APPLICATION JOB S61TE,APT
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Legal Description of Property - iriclude all easemdnts
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EXISTING - REQUIRED DEDICATION
Street Use Permit Req'd 0
PROPOSED
Inspection Required 0
Sidewalk Required 0
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METER SIZE
LINE SIZE
PRV REQUIRED
YES 0 NOO
3EMARKS
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SEPA REVIEW SIGN AREA HEIGH
COMPLETE EXEMPT ALLOWED IPROPOSED ALLOWED I PR . OPOSED
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LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.j
ALLOWED I PROPOSED FRONT SIDE REAR . FRONT UR Sl DE REAR
Pro party
Tax Account
LOT AREA I
PLANNING REVIEW By DATE
Parcel No.
PKNPLUMBINGtMECH
REMARKS
NEW RESIDENTIAL
COMPLIANCE OR
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1:1 ADDITION CHANGE OF USE
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REMODEL SIGN
GRADING FENCE
FIREPAIR
HECKED BY TYPE 0 CONSTRUCTION CODE OCCUPANT
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FIDEMOLISH WOODSTOVE SWIM POOL
F� INSERT HOT TUB/SPA
PECIAL INSPECTOR OCCUPANT
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JAREA
REQUIRED
0 YES
LOAD
FGARAGE RETAINING WALL/
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REMARKS
ROCKERY RENEWAL
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
PROGRESS INSPECTIONS PER UBC.108
U) NUMBER NUMBER OF CRITICAL
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INUMBER
STORIE'S UNITS
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
6;2
FINAL INSPECTION REQUIRED
VALUATION FEE
PLAN CHECK FEE
BUILDING
HEAT SOURCE: GLAZING
PLUMBING
Plan Check No.
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewcqlks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work Is'Started Within 186 Days
STORM DRAINAGE FEE
"Applicant, on behalf of his or her spouse, heirs, assigns and
ENG. INSPECTION FEE
successors in interest, agrees to indemnify, defend and hold
'Ln. harmless the City of Edmonds, Washington, its officials,
447
m 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
PLAN C7ECK DEPOSIT
modify,'waive or reduce any requirement,of any city ordinance
0 nor limit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
provision."
I hereby acknowledge that I have read this application; that the
ATTENTION
APPLICATION APPROVAL
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
THIS PERMIT
This application is not a permit until
state laws regulating construction; and in doing the work authoriz-
AUTHORIZES
signed by the Building Official or his/her
ed thereby, no person will be employed in violation of the Labor
ONLY THE
WORK NOTED
Deputy; and fees are paid, and receipt is
Code of the State of Wa ng on relating to Workmen's Compensa-
tion Insurance aria .27.
INSPECTION
ac d in space provided.
�nowledge
SIGNATURE (OWNER R AGENTI DATE SIGNED
DEPARTMENT
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CITY OF
EDMONDS
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CALL FOR
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ATTENTION
INSPECTION -t7�7
----------
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
771-0220
ORIGINAL — File YELLOW Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
SECTION 109
PINK Owner GOLD — Assessor
102-87
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
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FROM:
PRETREATMENT PLANT DATE t
PLEASE SIGN
PROJECT
SITE ADDRESS
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PERMIT # lor-6 o 3 1 _ADB#1 DATE INSPECTED I I
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WORK TO BE INSPECTED—
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jk'field inspection was conducted to determine compliance with approved pla s. Final approval
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denotes that there are no objections from the above signed.. Department to the release of
PERFORMANCE BONDS and the granting of
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GRANT. FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED.
Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
UvrEM P�BU ILDINGTORM S\PR E'rREATM ENTAPPROVAL. DOC 1 /4/2005
7- -7
RECORD OF INSPECTIONS
INSPECTOR
DATE
APPROVED
SETBACKS ...... ............
FOUNDATION:
Footing... ...... ............
Wall .......................
Pier/Porch .......... *
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RetainingWall ............
Slab Insulation ............
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PLUMBING:
Underground .............
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Hough -In .................
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Commercial Final ......
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HEATING:
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GasTest .......... ......
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Gas Piping ..........
Equipment ................
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Commercial Final .........
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EXTERIOR SHEATHING
NAILING ........ ............
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FRAMING ...............
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INSULATION:
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Floorinsulation .........
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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 OCCUPANCY ..........
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