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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PERMIT EXPIRES
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FLAT NAMEISUBDIVISION NO I LOT 110, LID 10-
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP 11 '"' 9
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REMARKS
OWNFRICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDITAINAGE
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STATE LICENSE NUMBER EXPIRATION -VARIANCE OR CU I SHORELINE OR ADBY I INSPECTION _BOND.
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PR PERTYTAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
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PARKING LOT ARIA PLANNING 11VIEWE. BY DATE
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Description
FEE Description FEE
Plan Check
State Surcharge
GLAZING % LOT SLOP, %
Building Permit
City Surcharge
PLAN CHECK NO:
tumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORKTO
1: HE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON TH PUBLIC
2
Grading
13
:I OMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
---
PE MITAPPLICATION: INDAYS
Engr. Review
PERMITLUAR.1 YMPROVID D WORK IS STARTED WITHIN 1110DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLIC * ON BEHALF 01 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
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT, ISSUANCi OF THIS PERMIT SHALL HOT BE
DEEMED TO MODIFY, WAIVE OR REDU E ANY HEOUIREMENT OF ANY CITY ORDINANCE
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Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee
I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATtO N
APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE DIANE . I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
This application Is not a penaltInIfil.1pred by Me
TION; AND IN DOING THE WORK AUTHORIZED THERE&, NO PERSON WILI BE EMPLOYED
IN VIOLAT 0 1- IE LABOR F THE STATE 01 WASHINGTON IELAI IN. To
COWE
FOR INSPECTION
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OFFJCI�LS SIGNAW& DATE
SIGNAT
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771-0220
RELEASED BY We
ATTENTION
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
'�/ORIGINAL- FILE OW - INSPIC;dR
�JU.
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK - OWNER � ASS Seen
OV02 PRESS HARD -YOU ARE MAKING 5 COPIES GFTEEN,ACCOUNTING
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FINAL PROJECT APPROVAL FORM
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DATE:
hMMO TO: PERMIT COORDINATOI;� 13UMDING DIVISION
FROM:
--TIRE DEPARTMENT DATE
----YNGMERING DIVISION DATE—,
DIVISION DATE —
PROJECT
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A field inspection was conducted to determine final compliance with approved plans. Final approval
denotes that there are no objections from the above signed Department to the release of
p_ERFORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
c3 Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
13 Copy of CORRECTION NOTICE, given to owner/contractor by inspector
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2.
3.
RE -INSPECTED OUTSTANDING ISSUES - iGRANT FINAL PROJECT APPROVAL
Date sign_
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS ..........
FOUNDATION:
Footing ....................
wall ..............
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Pier/Porch .................
Retaining Wall ...........
Slab Insulation
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PLUMBING:
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Underground
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Rough -In ..............
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Commercial Final
HEATING:
Gas Test
...........
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Gas Piping ...........
Equipment .........
IT1 ITI
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Commercial Final
0
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EXTERIOR SHEATHING
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NAILING ......................
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FRAMING ...........
FIRST FLOOR FRAM IING...
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INSULATION ..........
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Floor Insulation
Wall Insulation ...........
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Ceiling Insulation
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SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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