20051089.pdfDATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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VALUATION
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Description FEE Description FEE
HEAT SOURCE LOT SLOPE9. VESTED DATE Plan Check State Surcharge
Building Permit City Surcharge
PLAN CHECK NO:
Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTEd THIS PERMIT COVERS WORK TO M . echanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION. Grading
PERMIT APPLICATION: SEE ECDC 19.00,005(A)(5) Engr. Review Recording Fee
PERMIT LIMIT: SEE ECDC 19.00,005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection Plan Chk. Deposit
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS �J.
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF Fire Review Receipt #
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY Fire Inspection Total AmIl. Due
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.' Landscapelnsp. Receipt ft
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF CALL This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC_ FOR INSPECTION Building Otficial at his/her Deputy- and Fees are paid. and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED receipt is acknowledged in spice provided
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27. OFFICIALS SIGNATFV D TE
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R V DATE SIGNED
SIG REIOWNr:% G
771-0220
R 'E B DA
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EXT. 1333
AtTENTION
IT IS UNLAWFUL 0 E OR OCCU A BUILDING OR STRUCTURE UNTIL
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A FINAL INSPE T1 N HAS BEENIADE AND APPROVAL OR A CERTI- ORIGINAL - FILE e YELLOW - INSPECTOR
;:IrATF: OF OCCbANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110. PINK -OWNER - GOLD - ASSEsson
6/05 PRESS HARD - YOU ARE MAKING 4 COPIES
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FINAL PROJECT, APPROVAL FORM
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MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE.
PLEASUSIGN
ENGINEERING DIVISION DATE
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A. field inspection was conducted. to determine compliance with appr.' ved plans. Final approval
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denotes that there are no objections frorn the above signed Department to the release of
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PERFORMANCE BONDS* and the granting, of
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FAILED FINAL INSPECTION.- OUTSTANDING ISSUES
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:forms:ocaprv1 3/25/04
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall...........................
Pier/.Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
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Underground .............
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Rough -.In ...................
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HEATING:
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Gas Test ....................
Gas Piping .................
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Equipment ..................
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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 ................
Floor Insulation .........
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Wall Insulation ............
Ceiling Insulation .......
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SHEETROCK NAILING ...
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SPECIAL INSPECTION ...
MISCELLANEOUS ..........
-FINAL APPROVAL FOR
OCCUPANCY ..................