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PERMIT EXPIRES 1J ) j %
CITY OF EDMONDS
uiNUSE E PERMIT �` .�ff NUMBER
CONSTRUCTION PERMIT APPLICATION
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LEGAL DESCRIPTION CHECK
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METER SIZE
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NO OF FI%TURES
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— ADDRESS
REMARKS
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COMPLETE I EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
p LEGAL DESCRIPTION OF PROPERTY- INCLUDE ALL EASEMENTS
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❑ NEW �I/I RESIDEJNTIAL ❑ PLUMBING I MECH
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❑ ADDITION ❑ COMMERCIAL ❑ COMPLIANCE OR
CHANGE OF USE
❑ REMODEL APARTMENT ❑ SIGN
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❑ REPAIR ❑ CYDS ❑ ( % _ FT)
OTHER
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❑ DEMOLISH ❑ TANK liq�'tjA►l K IS1G
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CHECKEDBY TYPE
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OCCUPANT 7
GROUP RJ
SPECIAL INSPECI'On AREA
REQUIRED ❑ YES
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LOAD
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(TYPE OF USE. BUSINE�A VIT LAIN:
REMARKS
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GNUMBER
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VALUATION
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BUILDING
PLAN CHECK NO:
VESTED DATE
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORN TO
GRADINGIFILL
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS,SIDEWALKS, DRIVEWAYS, MAROUEES.ETC.) WILL REQUIRE
SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT APPLICATION: 180 DAYS
STORM DRAINAGE FEES
PERMIT LIMIT: i YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
"nPPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
E IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
E_MIONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMSFOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLYOR INDIRECTLY
o FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
o DEEMEDTOMODIFY, WAIVE OR REDUCE ANY REOUIREMENTOF ANYCITY ORDINANCE
PLAN CHECK DEPOSIT
— .NORLIMIT INANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
TOTAL AMOUNT DUE
-'` -17
1.
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
ALICATION APPROVAL
!E 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
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
W I COAIPENSATK N INSURANCE AND RCW 18.27.
CALL T s a hcalion Is not a pormil until signotl by Iho
BUII ng cwl cr his/her DopWy: pntl Foas aro paltl, antl
FOR INSPECTION olpl is achnpwlsdg tlmspncp p,o dotl
__j
I TUREI OR AGENT' DATE SIGNED
S
(425) OF SGNAT%RE
771-0220
/ DATE'
S
ATT�NTION
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ELEASED BY
DATE
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
S��r—vim
ORIGINAL FILE YELLOW INSPECTOR
PINK OWNER COLD ASSESSOR V
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R 77 ., E D FINAL PROTECT APPROVAL FORM
k; " 51999 TO:
DEVELOPMENTSE � CTIL
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: - - � - FIRE DEPARTMENT DATE 1,) - t ? r y�
T PL¢A 31S
ENGINEERING DIVISION DATE
PLWESIQM
PLANNING DMSION DATE
PLF.ABS1W
PROJECT
SITE ADDRESS (< U 7 aL [% t ✓ ,% C
PERMIT # 1? O �' `! ADB# DATE INSPECTED / 2- - t 9 k
DESCRIPTION OF WORK TO BE INSPECTED Z3��2�.� � r/'H—
A field inspection was conducted to determine compliance with approved plans. Final approval denotes that
there are no objections from the above signed Department to the granting of:
k Final approval of the described work
Performance gonds associated with the project maybe released `L 0 c " -7(, 3 G
_GRANT FINAL PROJECT APPROVAL
GRANT FINAL PROJECT APPROVAL WITH CONDITIONS NOTED
1.
_FAILED FINAL INSPECTION - OUTSTANDING ISSUES
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
\. 0
ocaprvl. doc.l: temp:bldg:forms6/98
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Footing......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in ...................
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING .........................
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ... -
SPECIAL INSPECTION ...
MISCELLANEOUS `..........
_ FINAL AP$HOVAL FOR
OCCUPANCY, ..................
32XI
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