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DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ER NAME/NAME OF BUSINESS
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CITY
NAME
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PERMIT EXPIRES
PERMIT
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PLAT NAME,SUBDIVISION NO,
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LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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REQUIRED DEDICA1 ION
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METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
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REMARKS
OWNER(CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ENGINEERING REVIEWED BY
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PROPOSED SETBACKS (FT)
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ULTIFAMILY
SIGN
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REMARKS
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Description
Plan Check
HEAT SOURCE
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7VESTED DATE
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Building Permit
PLAN CHECK NO:
Plumbing
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. T41S PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Mechanical
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Grading
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
Engr. Review
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
Fire Review
Fire Inspection
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 LIM IT IN ANY WAY. THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
LandscapeInsp.
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
CALL
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
FOR INSPECTION
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
(425)
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DAT E SIGNED
A�4-� //s
771-0220
E X T. 13 3 3
ATTENT19N
IT IS UNLAWFVO USE OR 0
A FINAL INSPECTION HAS B
FICATE OF OCCUPANCY HAS
6/05
FEE Description
State Surcharge
City Surcharge
Base Fee
FEE
Recording Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This appiication is not a permit until signed ey the
Buticling 011icial or his/her Deputy and Fees are pict. Ind
receipt is acknowledged in Space provided
f-ic,��Ls SI DATE
Y1 / / I / DATE
'Y A BUILDING OR STRUCTURE UNTIL
MADE AND APPROVAL OR A CERTI- ORIGINAL - FILE YELLOW - INSPECTOR
I GRANTED. UBC1 09 / IBC1 10 / IFIC1 10. PINK -OWNER GOLD - ASSESSOR
PRESS HARD - YOU ARE MAKING 4 COPIES
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FINAL PROJECT. APPROVAL FORM
TO:
DATE:—
MEMOTO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: IRE DEPARTMENT DATE
rLEASESIGN
ENGINEERING DIVISION DATE
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PLANNING DIVISION DATE
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PERMIT 42-C)V,�_ ADB# DATEINSPECTED 37. U- 0(�
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DESCRIPTION OF WORK TO BE INSPECTED - K
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A field inspection was conducted to determine compliance with -approved plans. Final approval
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denotes that there are- no objections from the above signed D se
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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
Ef Copy of CONDITIONS given to owner/cofttractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1: temp:bldg: forms: ocaprvl 3/25/04,
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing .......................
Wall ..........................
Pier/Porch
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Retaining Wall ...........
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Slab Insulation ..........
PLUMBING:
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Underground,. ..........
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Rough�ln ...................
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Commercial Fin al .......
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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 .......
3:9
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EXTERIOR SHEATHING
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NAILING ............... ..........
0 M
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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 ...
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
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-OCCUPANCY ................
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